儿童跟骨关节内骨折手术复位的体会

目的 探讨儿童跟骨骨折手术治疗效果.方法 2004年起收治男童跟骨骨折5例,共6足(双侧1例,右足3例,左足1例).平均手术年龄9.6岁(4～12岁).按Essex-Lopresti分型,5足为关节内压缩型,1足为舌型.手术取足外侧"J"形切口,跟骨外侧骨块掀开作内侧壁复位后植入松质骨,重建接骨板固定.术后石膏外固定.结果 平均随访24个月(8～31个月),6足踝关节活动无任何障碍,行走无疼痛感.手术前后X线片比较Bohler's角平均改善16.6°(8°～26°).1例1足因伤口不愈继发感染.结论 开放复位与内同定治疗有移位的关节内跟骨骨折不仅适用于儿童.而且没有成年人跟骨骨折后常见的腓侧肌腱炎、着地疼痛、穿鞋不舒适等并发症.

Open reduction of jntra-articular calcaneal fracture in children

Objective To explore the results of operative treatment for pediatric caleaneal fraetures.Methods Five boys aging 4-12 year(mean 9.6yr)with displaced intra-articular calcaneus fracture were treated.There were bilateralin one case,right side in 3 and left side in 1.The X-ray film showed that 5 cases belonged to Essex-Lopresti's joint-depression-type and one Essex-Lopresti's tongue-type.All patients underwent open reduction and internal fixation with bone graft and steel plates through J-shaped lateral approach,and plaster cast fixation.Results The follow-up period with an average of 24 months(range 8-31 months)showed that the movements of ankle were in normal range without pains.A comparison of preoperative and postoperative X-ray films demonstrated that Bfhler's angle has been improved in an average of 16.6(range 8 to 26).One case had wourid infeetion.Conclusions Pediatric patients with obvious displaced intra-articular calcaneal fracture can be treated by open reduction and internal fixation successfully.The author consider that pediatric patients haven't presented with any postoperative complications common to the adults,such as peroneal tendinitis,shoe wearing problems and uncomfortableness on the feet.