跟骨骨折的手术治疗  

Surgical treatment of calcaneus fractures

作　　者：白晓东[1] 邢更彦[1] 姜川[1] 王明新[1] 王振宇[1] 杜明奎[1] 

机构地区：[1]武警总医院骨科,北京100039

出　　处：《中华创伤杂志》2007年第6期412-416,共5页Chinese Journal of Trauma

摘　　要：目的 探讨跟骨骨折的特点、骨折分型，分析手术方法及创伤并发症的防治。方法 自1998年7月至2003年11月，共收治跟骨骨折58例，按Essex—Lopresti系统分型，其中关节外骨折16例；关节内骨折42例，包括关节压缩性骨折24例和舌形骨折18例。关节外骨折为稳定性骨折，采取闭合复位，非负重石膏管型固定；涉及后关节面明显移位骨折采取手术治疗，跟骨后关节面解剖复位，跟骨解剖接骨板内固定；后关节面严重粉碎骨折，同时行距下关节Ⅰ期融合。结果 本组手术治疗的患者随访2～7年，平均3．6年。根据患者的主诉、后跟的外形及距骨下关节的功能及X线征象，尤其是Bohler角的恢复来评价临床疗效。其中优16例（38％），良17例（40％），可6例（14％），差3例（7％），优良率为79％。本组患者术后无感染；后跟变宽，足底扁平6例；7例距骨下关节炎，其中3例因跟骨后关节面塌陷出现严重疼痛性关节炎，行距骨下关节融合手术。1例切口皮瓣顶端坏死、缺损。结论有移位的跟骨关节内骨折非手术治疗并发症多而且后果严重，手术切开复位尤其是后关节面的解剖复位对患者功能的恢复及并发症的防治极其重要。Objective To study the characteristics and classifications of calcaneus fractures and analyze surgical methods and prevention of complications. Methods Fifty-eight cases with calcaneus fractures were admitted in our department from July 1998 to November 2003. According to the Essex-Lopresti classification, there were 16 cases with extra-articular fractures and 42 wiht intra-articular fractures including 24 with joint decompression fractures and 18 with tongue-type fractures. For stable extra-articular fractures, closed reduction with non-weight bearing was used. Open reduction through the lateral extensile incision, and anatomic reduction of the posterior facet and fixation with anatomic plate were applied to treat intra-articular fractures. Primary subtalar fusion was used simultaneously if there existed severe comminuted fracture of posterior articular surface. Results All cases treated surgically were followed up for 2-7 years （ average 3.6 years）. The curative effect was assessed based on the complaints of cases, the contour of the heel, the function of the ankle and subtalus and the X-ray manifestations, especially the restoration of Bohler＇ s angle. The results showed that 16 cases （38%） were rated excellent, 17 （40%） good, 6 （14%） fair and 3 （7%） poor, with excellence rate of 79%. No infection was found. Broadened heel and flattened sole of foot were found in 6 cases and subtalar arthrosis in 7 including 3 with severe pain and collapse and deformation of the posterior facet of calcaneus that were managed with arthrodesis. Skin necrosis of apex of the incision occurred in one case. Conclusions As for intraarticular fractures with displacement, nonsurgical treatment may cause severe complications of intra-calcaneus fractures but surgical open recuction especially reduction of posterior facet are important in functional recovery and prevention of complications.

关 键 词：跟骨 骨折固定术 内 解剖复位 

分 类 号：R686[医药卫生—骨科学]