跟骨关节内骨折的手术治疗  

Surgical treatment of intraarticular fractures of the calcaneus

作　　者：张家红[1] 董海[1] 戴力扬[1] 

机构地区：[1]上海第二医科大学附属新华医院骨科,上海200092

出　　处：《临床骨科杂志》2001年第2期135-136,共2页Journal of Clinical Orthopaedics

摘　　要：目的　介绍应用克氏针固定跟骨关节内骨折的手术方法和临床疗效。方法　采用足外侧入路关节面复位、克氏针内固定治疗 3 6例患者 ,比较不同骨折类型的治疗效果和不同复位质量病例的临床疗效 ,评价手术治疗病例的并发症情况。结果　参照Maryland提出的评分系统 ,临床疗效优良率为 82 % ,其中Ⅰ型优良率 10 0 % ,Ⅱ型优良率 78% ,Ⅲ型优良率 64%。放射学评价达解剖复位的 2 5例中疗效优良 2 2例 ,复位一般 9例中疗效优良 6例 ,复位差的 2例疗效均差。手术并发症发生率为2 2 %。结论　应用克氏针固定加植骨治疗跟骨关节内骨折有较好效果 ,临床治疗结果与软组织损伤程度、骨折类型、复位质量有关。Objective To introduce the surgical technique and the clinical outcome of intraarticular fractures of the calcaneus by open reduction and internal fixation with Kirschners wires. Methods 36 patients were treated by the articular facet reduction and internal fixation with Kirschners wires by lateral approach. The clinical results were compared among different types and evaluated according to the quality of reduction respectively. Results 82% of the patients had satisfactory results according to evaluation system suggested by Maryland, and 25 fractures got anatomical reduction. 100% of type Ⅰ, 78% of type Ⅱ,and 67% of type Ⅲ fractures had good or excellent results. Of the 25 fractures achieved anatomical reduction, 22 cases had satisfactory outcome. In contrast, of the patients with fair or poor results, only 6 cases obtained good results. 8 cases (22%) were found to have complications in which 6 (17%) were related to soft tissues. Conclusion Open reduction and internal fixation utilized Kirschners wires and bone grafting is a satisfactory method for intraarticular fractures of the calcaneus, but the results of surgical treatment are affected by local soft tissue damage, clinical type of the fractures and the quality of reduction.

关 键 词：跟骨骨折 骨折固定术 治疗 

分 类 号：R683.420.5[医药卫生—骨科学]