复杂跟骨骨折的手术治疗

目的探讨手术治疗复杂跟骨骨折的方法，评价临床效果。方法按照Sander分型标准，筛选符合Ⅲ型和Ⅳ型跟骨骨折的患者，共计手术复位内固定治疗复杂跟骨骨折27例30足，其中陈旧性骨折4例5足，均使用国产跟骨钛钢板固定，其中10足辅以钢板外螺丝钉、克氏针固定，1例Ⅳ型骨折早期行距下关节融合术。结果按照Maryland foot Scone足部功能评分系统指标评价，以每一只足为分析基数，优18足，良5足，优良率76．7％；可3足，差4足，其中有2足Ⅳ型骨折和1足陈旧性骨折，差的4足均为陈旧性骨折。结论手术内固定是复杂跟骨骨折治疗的首选方法，骨折复位和固定的质量影响着手术效果。恢复距下关节及跟骰关节面，维持正常的足弓形态，调整好Bohlers角和Gissans角，恢复跟骨的长度、宽度和高度，选择良好的内固定，是手术复位固定重点。早期手术治疗，可以提高临床疗效。

Operation of Complex fracture of calcaneus

Objective To explore the method and effect of Complex fracture of calcaneus.Methods 30 feet of27 patients with calcaneal fracture of type Ⅲ or Ⅳ were treated with open reduction and internal fixation from january 2004 to January 2008.All patients were operated with titanium plate.10 feet of them were added with serew and Kirschner pin.1 cases of type Ⅳ was operated with fusion of subtalar ioint.Results All patients were followed up.According to Maryland foot Score system,18 feet were excellent,5 feet were good,3 feet were moderate,4 feet were bad.The excellent and good rate was 76.7%.Conclusion Operation is the best treatment for complex calcaneal fracture.Anatomical reduction and firmly fixation were the key to the operation.