移位型跟骨关节内骨折的手术治疗进展  

Progress of the operative treatment for displaced intra-articular calcaneal fractures

作　　者：梁先勇[1] 陈志伟[1] 

机构地区：[1]南华大学附属第一医院骨科,衡阳421001

出　　处：《中国骨与关节杂志》2016年第4期279-283,共5页Chinese Journal of Bone and Joint

摘　　要：跟骨骨折约占全身骨折总数的2%,是临床上最常见的跗骨骨折,其中75%为跟骨关节内骨折[1-2]。高处坠落是跟骨骨折最常见的直接暴力损伤因素,常伴有脊柱、骨盆等复杂骨折。Sanders[3]分型对跟骨骨折的诊疗及预后有着重要的指导意义,能充分反映跟骨后距下关节面的损伤情况,成为目前临床上应用最广泛的分型方法。由于跟骨周围解剖结构复杂、软组织条件差,跟骨骨折尤其是移位型关节内骨折治疗困难,容易导致各种足部并发症,Objective To review the progress of the operative treatment for displaced intra-articular calcaneal fractures. Methods Original articles on the operative treatment of displaced intra-articular calcaneal fractures were extensively reviewed. Indications, advantages and disadvantages of each surgical method were also analyzed. ResultsDisplaced intra-articular calcaneal fracture was complex with varied surgical methods, including percutaneous poking reduction and internal fixation, open reduction and internal fixation, external fixation, balloon reduction and cement fixation, subtalar arthrodesis, arthroscopic reduction and digital orthopedic techniques. However, open reduction and internal fixation was the most widely used method for displaced intra-articular calcaneal fractures with a fairly high complication rate. Percutaneous poking reduction and internal fixation, external fixation, balloon reduction and cement fixation were minimally invasive approaches, but they should be used carefully for the indications. Subtalar arthrodesis was not advocated for young patients, and was often used in severely displaced intra-articular calcaneal fractures and failures after the first internal fixation. Arthroscopic reduction and digital orthopedic techniques had become increasingly popular for offering a new way to the treatment. Conclusions Displaced intra-articular calcaneal fractures are severe foot injuries, while the damage degree and fracture type should be evaluated objectively. To improve clinical efficacy and reduce postoperative complications, optimal treatment should be chosen following the principle of being reasonable, effective and minimally invasive.

关 键 词：跟骨 骨折 关节内骨折 综述 

分 类 号：R687.3[医药卫生—骨科学]