波及距下关节的跟骨骨折的手术治疗  

Treatment of intra-articular fractures of calcaneus

作　　者：叶正云[1] 王海泉[1] 吴小松[1] 范军胜[1] 洪琦[1] 

机构地区：[1]湖北省荆门市第一人民医院骨科,448000

出　　处：《中华创伤骨科杂志》2005年第11期1040-1043,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨波及距下关节的跟骨骨折的手术治疗若干问题。方法自2000年8月～2004年7月我院收治的34例38足波及距下关节的跟骨骨折患者,骨折按Sanders标准分型:Ⅱ型22例24足,Ⅲ型9例11足,Ⅳ型3例。单纯松质骨螺钉内固定2例2足,克氏针加螺钉内固定4例5足,可塑性跟骨钛板内固定28例31足。结果全部患者随访3～48个月。34例38足中30例34足切口Ⅰ期愈合,切口皮肤坏死3例3足,经换药自行愈合1例,二期缝合愈合1例,皮瓣转移覆盖1例。切口感染1例1足,经长期换药,后取除内固定愈合。2例足外缘皮肤感觉麻木。按Marylandfootscore评分标准:优19足,良9足,中8足,差2足,优良率73.6%。结论对于波及距下关节的跟骨Ⅱ、Ⅲ、Ⅳ型骨折应采取手术治疗,可降低病残率,显著提高患者的生存质量。Objective To discuss surgical treatment of intra-articular fracture of calcaneus involving subtalar joint. Methods From August 2000 to July 2004, 38 feet of 34 patients with calcaneal fracture involving subtalar joint were operated on in our department. According to Sanders classification system, 24 feet were of type Ⅱ, 11 feet of type Ⅲ and 3 cases of type Ⅳ. 2 cases with 2 feet were treated with internal fixation of innocence cancellous bone screw, 4 cases with 5 feet were treated with internal fixation of Kirschner pin and screw, and 28 cases with 31 feet with internal fixation of plastic calcaneus titanium plate. Results All the patients were followed up for 3 to 48 months. As for incisions, 30 cases with 34 feet healed by first intention, but 3 cases with 3 feet experienced necrotic skin of incision, of whom 1 healed by changing dressings, 1 healed by second suture, and 1 was treated with flap covering. 1 case with 1 foot experienced infection but healed by removal of internal fixation after long-time dressing changing. 2 cases experienced numbness of outer skin. The results were excellent in 19 cases, good in 9, fair in 8, and poor in 2 according to Maryland foot score standard. The excellent and good rate was 73.6%. Conclusions Operative treatment is fit for calcaneal fractures of Sanders types Ⅱ,Ⅲ and Ⅳ because it can decrease severe disability and improve the quality of life of the patients.

关 键 词：跟骨骨折 骨折固定术 内 手术治疗 波及距下关节 跟骨骨折 手术治疗 MARYLAND 螺钉内固定 骨折患者 Ⅰ期愈合 切口感染 皮瓣转移覆盖 

分 类 号：R687.3[医药卫生—骨科学]