内侧入路切开复位内固定治疗跟骨单纯载距突骨折

 目的　探讨内侧入路切开复位内固定治疗跟骨载距突骨折的临床疗效。方法　回顾性分析2006年9月至2011年3月采用内侧入路切开复位空心拉力螺钉或克氏针内固定治疗23例跟骨单纯载距突骨折患者资料，男19例，女4例；年龄17～41岁，平均26.3岁；右侧14例，左侧9例。伴随损伤：合并距骨骨折4例，跖骨骨折4例，骰骨骨折3例。其中17例载距突骨块移位 ＞1 mm，6例骨折线累及中距下关节面。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝与后足评分标准对手术前后足部功能进行评估。结果　跟骨载距突骨折均固定可靠，骨折临床愈合时间8～10周，平均8.5周。15例患者获得随访，随访时间10～56个月，平均20.5个月。末次随访时AOFAS踝与后足评分80～100分，其中优2例，良13例，优良率为100%(15/15)。3例患者恢复行走时有轻微一过性疼痛症状出现，经热敷等理疗后症状消失；无一例患者发生伤口感染、骨不连、长屈肌腱腱鞘炎、跗管综合征等严重并发症。结论　采用内侧入路切开复位内固定治疗移位超过1 mm或骨折线累及中距下关节面的单纯跟骨载距突骨折术后疗效满意。

Surgical treatment of isolated fractures of the sustentaculum tali of calcaneus

Objective To evaluate the clinical results of surgical treatment of isolated fractures of the sustentaculum tali of calcaneus via medial approach. Methods The data of 23 patients with isolated fractures of the sustentaculum tali of calcaneus was retrospectively analyzed who were treated with open reduction and internal fixation with cannulated screw or Kirschner wire via medial approach from September 2006 to March 2011. There were 19 males and 4 females, with an average age of 26.3 years (range, 17-41 years). Associated injuries included 4 cases of talus fracture, 4 of metatarsal fracture, and 3 of cuboid fracture. The functions of hindfoot were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores pre-operation and post-operation respectively. Results Fifteen patients got followed up with an average 20.5 months (10-56 months). Thirteen patients were rated as good, 2 as excellent, and the excellent and good rate was 100%(15/15). All the fractures were stabilized reliably, and got clinical union with no obvious complications occurred. Time of fracture union was 8-10 weeks, with an average of 8.5 weeks. Three patients felt mild transient pain during the recovery of walking, but their pain disappeared quickly after physical therapy. No patients developed wound infection, nonunion and other complications. Conclusion For isolated fractures of the sustentaculum tali of calcaneus with articular surface displaced greater than 1 mm or involving the articular surface of middle subtalar joint, open reduction and internal fixation operation via medial approach under direct visualization is recommendable.