跟骨关节内骨折40例手术治疗的疗效观察

目的分析并探讨手术治疗跟骨关节内骨折的临床疗效并防治并发症。方法选取本院2010年6月～2011年12月收治的40例跟骨关节内骨折的患者（共45足）,采用改良的外侧入路切开复位钢板内固定手术治疗,观察分析骨折愈合情况及并发症的发生情况。结果随访8～24个月,平均随访时间为16个月。骨折全部愈合,无内固定松动及再骨折发生。按Maryland足部评分标准对手术效果进行评价,其中,优29足,评分在90～100分;良10足,评分在75～89分;可4足,评分在50～74分;差2足,评分〈50分,优良率为86.7%。结论关节的复位和牢固的固定是跟骨关节内骨折的手术治疗的关键。对于SandersⅡ～Ⅳ型的跟骨关节内骨折,疗效方面理想,尤其对于跟距关节面的骨折以及移位明显的跟骨关节内骨折疗效更为可靠,实施手术治疗是必要的,临床上值得推广使用。另外重视对距下关节面的复位及重建距下关节面的完整性,可以有效地避免并发症。

The clinical effect observation of surgical treatment of 40 patients with intra-articular fractures of calcaneal

Objective To analyze and explore the clinical efficacy and prevent complicitions of surgical treatment of intra-articular calcaneal fractures. Methods Torty patients （45 feet） with intra-articular calcaneal fractures in our hospital from June 2010 to December 2011 were chosen and treated with a modifid lateral approach incision reposition and internal fixation with steel plate, Fractures cure effect and complications were observated and analyzed. Results The follow-up time was 8 to 24 months with the average of 16 months. All patients were fractures healed without internal fixation loosening and re-fracture. According to the Maryland foot score, 29 feet were excellent with the scores of 90-100, 10 feet were good with the scores of 75-89, 4 feet were general with the scores of 50-74, 2 feet were not good with the scores below 50. The total excellent and good rate was 86.7%. Conclusion The joint reduction and rigid fixation is the key of good effect of the surgical treatment of inra-articular fractures of calcaneal. Intra-articulau calcaneal fractures with Sanders Ⅱ-IV type has an ideal effect, especially for intra-articular calcaneal fractures with articular surface and shift significantly, surgical treatment is necessary and is worthy of widely use in clinic. In addition, it should be attention to the integrity of the subtalar articular surface reduction and reconstruction to avoid the occurrence of complications effectively.