切开复位固定+不植骨治疗Sanders Ⅲ型和Ⅳ型跟骨骨折  

Open reduction and internal fixation without bone graft for treatment of Sanders type Ⅲ and type Ⅳ calcaneal fractures

作　　者：才忠民[1] 尚平[1] 王琦[1] 吴峰[1] 

机构地区：[1]广州市花都区人民医院骨科,510800

出　　处：《中华关节外科杂志（电子版）》2014年第4期20-22,共3页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨切开复位固定、不植骨治疗SandersⅢ、Ⅳ型跟骨骨折的手术方法及疗效。方法 2008年1月~2011年11月,应用跟骨外侧手术入路、切开复位解剖钢板固定、不植骨治疗跟骨粉碎性骨折66例、77足。其中男45例,女21例,11例为双侧。年龄22~55岁,平均37岁。根据Sanders分型,Ⅲ型17足,Ⅳ型60足。结果本组66例患者均获随访,获随访12~18个月,平均15个月。77足切口均Ⅰ期愈合,随访中无螺钉退出、断裂等现象。除5例合并股骨骨折的的病例,其余半年后均能正常行走。术前Bǒhler’s角（4.6°±6.2°）,术后（31.6°±7.4°）;术前Gissane’s角（158.12°±8.57°）,术后（136.58°±6.85°）,各指标手术前后比较差异有统计学意义。按Maryland足部评分系统评价术后功能,本组77足中,优（90~100分）68足,良（75~89分）8足。可（50~74分）1足,优良率98.7%。结论通过本方法治疗跟骨骨折,能够良好的维持跟骨的解剖形态,足的功能恢复满意,且明显降低了植骨术后的排异反应及切口不愈合的发生,有效的减轻了患者的痛苦和经济负担。Objective To study the effects of open reduction and internal fixation （ ORIF） without bone graft for type Ⅲand type Ⅳcalcaneal fractures .Methods 66 cases （ including 51 feet in 45 males and 26 feet in 21 females, aged from 22 to 55） of calcaneal fractures were enrolled from January 2008 to November 2011.According to Sanders ’ classification, 17 cases were classified as type Ⅲ and 60 cases were type Ⅳ.All the patients underwent open reduction through the lateral extensile incision and the internal fixation without bone graft .Results All the cases treated surgically were followed up for 12-18 months （average 15months）.77 feet achieved primary healing.No backing out or fracture of the screw occured.Except five patients who combined with the femoral fracture , all the other patients were able to walk properly six months after the surgery .The preoperative X-ray examination showed that Bǒhler angle was （4.6°±6.2°） and Gissane angle was （158.12°±8.57°）; the postoperative X -ray examination demonstrated that Bǒhler angle was （31.6°±7.4°） and Gissane angle was （136.58°±6.85°）; there were statistically significant diffrerences .According to the Maryland evaluation system for foot , 68 feet scored 90-100 points, eight feet scored 75-89 points and one foot scored 50-74 points.The excellent rate was 98.7%.Conclusions Open reduction and internal fixation without bone graft is an effective method to treat the calcaneus fracture .The technique may contribute to maintaining the anatomical shape of calcaneus and the foot function recovery .It can significantly reduce the incidence of non -healing of the wound and relieve the suffering and economic burden of the patient .

关 键 词：跟骨 骨折固定术 解剖复位 

分 类 号：R687.3[医药卫生—骨科学]