跟骨关节内骨折的手术治疗和并发症防治

目的探讨跟骨关节内骨折切开复位钢板内固定及术后并发症防治的方法和疗效。方法本组28例30足。术前均行X线摄片及CT检查按Sanders分型:Ⅱ型6足、Ⅲ型17足、Ⅳ型7足。闭合性骨折28足,开放性骨折2足。均采用跟骨外侧"L"型切口跟骨钢板内固定,必要时植骨。术后按Maryland足部评分系统进行功能评定。结果本组28例患者均获随访。所有患者无深部感染、骨髓炎、骨不连。Maryland足部评分优良率93.3%。结论跟骨关节内骨折切开复位钢板内固定是值得肯定的治疗方法。只要我们能准确把握手术时机,充分术前准备,术中有良好的复位和可靠的固定,并进行必要的植骨。对术后并发症有正确的认识,尽早干预就可以获得理想的疗效。

Surgical treatment for intra-articular calcaneal fractures and the prevention of complications

Objective To evaluate the clinical effects of open reduction and internal plate fixation for the treatment of intra-articular calcaneal fractures and complication prevention methods.Methods 30 feet of 28 patients with intra-articular calcaneal fractures were analyzed.X-ray and CT scans were applied in all patients preoperatively.The cases were classified according to Sanders classification：6 cases in type Ⅱ,17 in type Ⅲ,and 7 in type Ⅳ.There were 28 cases of closed fracture and 2 cases of open fracture.Lateral calcaneal ＂L＂ shaped incision calcaneal plate fixation was adopted,bone grafting when necessary.The postoperative evaluation of foot function was carried out according to scoring system of Maryland.Results 28 patients were followed up.None had deep infection,osteomyelitis,or nonunion.Maryland foot score excellent rate was 93.3%.Conclusion Intra-articular calcaneal fractures with open reduction and plate fixation is a positive method of treatment.As long as we can accurately grasp the timing of surgery,fully prepare before surgery,have a good and reliable fixation and necessary bone graft,we can achieve an ideal effect.