锁定加压钛板内固定治疗跟骨骨折

 目的 探讨应用锁定加压钛板内固定治疗跟骨骨折的临床疗效。方法 2008年1月至2011年12月收治并获得随访的跟骨移位的关节内骨折30例(40足)，男 25例(33足)，女5 例(7足)；年龄22~60岁，平均44.8岁。左侧15足，右侧25足；均为闭合性骨折，2例合并脊柱损伤。根据跟骨骨折Sanders分型，Ⅱ型20足，Ⅲ型15足，Ⅳ型5足。手术均采用跟骨外侧扩大“L”形切口，骨折复位后以锁定加压钛板固定。术后不予石膏外固定，早期行踝关节功能练习，术后6周部分负重，12周完全负重。采用美国足踝外科协会(American Orthopaedic Foot & Ankle Society, AOFAS)踝与后足功能评分评价足踝功能。结果 随访时间8~20个月，平均 12个月。骨折愈合时间8~12周，平均10 周。无延迟愈合、神经损伤及骨髓炎病例。1例出现切口裂开及部分钛板螺钉外露，经换药1个月后切口逐渐愈合。2例术后出现距下关节创伤性关节炎，行走时疼痛，其中1例行距下关节融合术后疼痛消失，另1例因经济原因拒绝行进一步治疗后失去随访。末次随访时AOFAS踝与后足功能评分结果为优20足、良17足、可3足，优良率92.5%(37/40)。结论 应用锁定加压钛板内固定治疗跟骨骨折有利于早期愈合和功能锻炼，术后软组织并发症发生率低。

Application of locking compression plate in treatment of calcaneal fractures

Objective To evaluate the clinical effect of the treatment for calcaneal fractures by locking compression plate. Methods From January 2008 to December 2011, 30 patients with 40 calcaneal fractures were operated with locking compression plate. There were 25 males (33 feet) and 5 females (7 feet) with an average age of 44.8 years (range, 22-60 years). Fifteen feet were on the left side, and 25 feet were on the right side. All patients had closed fractures, with complicated spinal injury in 2 patients. According to Sanders classification, 20 feet were type Ⅱ fractures, 15 feet were type Ⅲ, and 5 feet were type Ⅳ. The lateral approach was adopted for all the patients in the treatment in which locking compression plate fixation was used but no external fixation. Early and suitable rehabilitation was carried out postoperatively. The patients could bear part of the loading six weeks after the operation and all the loading twelve weeks after the operation. The results were validated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results The patients were followed up for 8-20 months (average, 12 months). Bone union occurred in all cases with roentgenographic evidence during 8-12 weeks postoperation (average, 10 weeks). None of the patients had such complications as nerve injury or osteomyelitis. Incision dehiscence occurred in one case in which a little part of titanium plate and screw was exposed, but the incision was healed by dressing 1 month later. Two patients had subtalar arthritis and suffered from the pain while walking. Of the two patients, the pain was relieved for one after the operation of subtalar joint fusion, and the other was lost to the follow-up after he or she refused further treatment for economic reasons. According to AOFAS foot score standard, the effects of 20 cases were excellent, 17 were good, and 3 were fair. The excellent and good rate was 92.5%. Conclusion The application of locking compression plate is an effective and satisfied treatment of calcaneal fractures which is beneficial for healing and functional exercise. Moreover, the rate of soft tissue complication after operation is low.