跟骨锁定钢板治疗跟骨关节内粉碎性骨折的疗效分析

目的 评价跟骨锁定钢板治疗跟骨关节内粉碎性骨折的疗效.方法 2006年10月至2007年12月,应用国际内固定研究学会(AO/ASIF)设计的跟骨锁定钢板治疗跟骨关节内粉碎性骨折21例,男12例,女9例;年龄24～78岁,平均42.5岁;左侧8例,右侧13例.骨折按照Sanders分型:Ⅲ型12例(Ⅲ型2例,Ⅲac型6例,Ⅲbc型4例),Ⅳ型9例.术后随访包括临床检查、问卷式调查、摄x线片及应用三维动态足底压力分析系统进行足底压力分析.采用Maryland足部评分标准进行足踝功能评分. 结果 18例获随访,时间10～21个月,平均15.5个月.骨折愈合时间7～14周,平均11.4周.无延迟愈合及不愈合,骨折端无移位,螺钉无松动、拔出及断钉.根据Maryland足部评分标准,患侧在末次随访时平均为81.7分(60～94分),其中优6例,良9例,一般3例.优良率为83.3%.末次随访X线片上的跟骨形态学指标较术前均有明显改善,差异有统计学意义(P＜0.05).三维动态足底压力测量结果提示无一例发生创伤件平足,患足躅趾、第1～5跖骨头平均峰值压力稍增高,差异有统计学意义(P＜0.05),足跟部平均峰值压力减小,差异有统计学意义(P＜0.05). 结论应用跟骨锁定钢板治疗跟骨关节内粉碎性骨折,有利于患肢早期负重锻炼,可获得较理想的临床疗效.

Open reduction and internal fixation for severely displaced intra-articular calcaneal fractures using calcaneal locking plates

Objective To evaluate the clinical outcome of calcaneal locking plates for treatment of the severely displaced intra-articular calcaneal fractures. Methods From October 2006 to December 2007, a total of 21 patients with severely displaced intra-articular calcaneal fractures were treated by open reduction and internal fixation using the ealcaneal locking plates. There were 12 males and 9 females with an average age of 42.5 (24 to 78) years. The left side was involved in 8 cases, and the right side in 13 cases. According to Sanders classification, 12 cases belonged to type Ⅲ, 9 to type Ⅳ. Functional assessment was done using the Maryland Foot Score and plantar pressures were measured with three-dimensional dynamic pedography (F-scan Mobile, Tekscan, USA) . Results Altogether 18 patients got a mean follow-up of 15.5 (10 to 21) months. All of their fractures healed in a mean time of 11.4(7 to 14)weeks without delayed union, nonunion, displacement, avascular necrosis, or failure of screws and plates. The mean Maryland Foot Score for the injured side at the last follow-up was 81.7 (60 to 94). Six feet were excellent, 9 feet good, 3 feet fair, and none poor. The indexes of calcaneal morphology at the last follow-up had a significant im-provement compared with the preoperative ones ( P ＜ 0.05) . The plantar peak pressures of hallucal and metatarsal heads increased and that of the heel decreased ( P ＜0.05), but there was no significant difference in the peak pressure of the midfoot ( P ＜ 0.05). Conclusion The calcaneal locking plates can be used to provide stable fixation with a good functional outcome for the severely displaced intra-articular calcaneal fractures and eliminate most hardware problems and complications.