切开复位钢板内固定治疗跟骨骨折  

Techniques in Open Reduction and Internal Fixation with Plate of Calcaneus Fractures and Collapse of Posterior Subtalar Joint Surface

作　　者：陈滨[1] 王刚[1] 张晟[1] 郭刚[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广东广州510515

出　　处：《实用骨科杂志》2009年第1期12-14,共3页Journal of Practical Orthopaedics

摘　　要：目的讨论切开复位钢板内固定治疗距下关节移位跟骨骨折的疗效。方法25例30足跟骨骨折病人,其中Sanders型骨折13足,型11足,型6足,切开复位AO钢板固定,必要时自体骨移植治疗。术中侧位C臂监测B¨ohler角,Broden位观察关节面情况,并于术后、6周、1年分别摄片观测B¨ohler角角度。所有病例随访12～30个月,平均1个月。结果采用AOFAS评分标准评测足部功能,优19足,良7足,可4足,优良率达87%。早期并发症其中切口皮缘坏死3足,腓肠神经损伤2足,远期并发症距下关节创伤性关节炎4例。结论对于合并距下关节损伤的跟骨骨折,治疗的主要目标在于恢复其正常的力学关系,术前评估软组织损伤和骨折类型显得尤其重要,同时尽量减少并发症的发生。Objectives Discuss the clinical outcome of open reduction and internal fixation with plate of calcaneal fractures and collapse of posterior subtalar joint surface. Methods Open reduction and internal fixation with plate combined with bone graft was performed on 25 cases（30 sides） of calcaneal fractures and collapse of posterior subtalar joint surface. According to Sanders classification,there were 13 feet of type ~ ,11 feet of type $ and 6 feet of type IV. Using C-arm to observe Bohler＇s angle in lateral view and articular surface in Bohler view during operation. Observe the restoration of Bohler＇s angle by radiography after 6 weeks and 1 year. All patients were followed up for an average of 18 months（from 12 to 30 months）. Results The results were excellent in 19 cases,good in 7 cases and fair in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good was 87~/00. The early postoperative complication were 3 cases necrosis of the skin incision margin,2 cases were sural nerve injury. The later complication was post-traumatic osteoarthritis of posterior subtalar joint in 4 cases. Conclusion The main objective in treating calcaneal fractures with subtalar joint related is to restore the normal me- chanical relation of the calcaneus. The preoperative assessment of soft tissue injuries is also very important as well as complications reducing.

关 键 词：跟骨骨折 内固定 术前评估 骨折并发症 

分 类 号：R683.42[医药卫生—骨科学]