改良跗骨窦切口解剖型锁定钢板内固定治疗Sanders Ⅲ-Ⅳ型跟骨骨折  

Improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders Ⅲ-Ⅳ calcaneal fractures

作　　者：杨彬 王德成 张兴国 王忠伟 YANG Bin;WANG De-cheng;ZHANG Xing-guo;and WANG Zhong-wei(Tongzhou Hospital of Integrated Tradi-tional Chinese and Western Medicine,Beijing 101100,China)

机构地区：[1]北京市通州区中西医结合医院骨科,北京101100

出　　处：《中国骨伤》2018年第7期599-603,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨改良跗骨窦切口解剖型锁定钢板内固定治疗SandersⅢ-Ⅳ型跟骨骨折临床疗效。方法:2015年2月至2016年10月采用改良跗骨窦切口解剖型锁定钢板内固定治疗SandersⅢ-Ⅳ型跟骨骨折35例,其中男22例,女13例;年龄22～68(42.3±12.7)岁;根据Sanders分型,Ⅲ型23例,Ⅳ型12例。观察术后并发症情况,比较手术前后跟骨B?hler角、Gissane角改变情况,并于术后12个月时采用Maryland足功能评分标准评价患足功能恢复情况。结果:35例患者获得随访,时间12～20(14.5±2.0)个月。切口长度4.0～5.5(4.7±0.4)cm。1例切口浅表感染,2例切口延迟愈合,腓肠神经损伤1例,随访无钢板外露、松动,无骨折复位丢失并发症。切口愈合时间14～28(15.4±4.7)d,骨折愈合时间8～14(9.8±1.9)周。B?hler角由术前的(9.81±14.28)°恢复至术后3 d的(26.35±11.04)°、术后12个月的(25.96±10.79)°,差异有统计学意义(P<0.05)。Gissane角由术前的(122.54±16.79)°恢复至术后3 d的(120.85±11.88)°、术后12个月的(120.62±11.44)°,差异有统计学意义。Maryland评分由术前的12.66±4.10提高至术后12个月的92.20±7.82,其中优32例,良2例,可1例。结论 :改良跗骨窦切口解剖型锁定钢板内固定治疗SandersⅢ-Ⅳ型跟骨骨折,切口小,软组织损伤程度低,并可获得良好的骨折复位与固定,是SandersⅢ-Ⅳ型跟骨骨折有效的微创治疗方法。Objective：To investigate clinical effects of improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders Ⅲ and Ⅳ calcaneal fractures. Methods：From February 2015 to October 2016,35 patients with Sanders Ⅲ and Ⅳ calcaneal fractures treated by improved anatomical locking plate internal fixation through tarsal sinus incision were collected,including 22 males and 13 females aged from 22 to 68 years old with an average of（42.3±12.7） years old. According to Sanders classification,23 patients were type Ⅲ and 12 patients were type Ⅳ. Postoperative complications were observed,B？hler angle and Gissane angle before and after operation were compared,and Maryland foot function scoring standard was evaluated at 12 months after operation. Results：All patients were followed up from 12 to 20 months with an average of（14.5±2.0） months,the length of incision ranged from 4.0 to 5.5 cm with an average of（4.7±0.4） cm. Superficial infection occurred in 1 patient,delayed union in 2 patients,gastrocnemius nerve injury in 1 patient. No complications such as steel plate exposure and fracture reduction loss occurred. Wound healing time ranged from 14 to 28 days with an average of（15.4±4.7） days,the fracture healing time ranged from 8 to 14 weeks with an average of（9.8 ±1.9） weeks. B？hler angle increased from preoperative（9.81±14.28）° to 3 days after operation（26.35±11.04）°,and（25.96±10.79）° at 12 months after operation（P0.05）. Gissane angle ranged from preoperative（122.54±16.79）° to 3 days after operation（120.85±11.88）°,and（120.62±11.44）° at 12 months after operation and had statistical meaning. Maryland score increased from 12.66±4.10 before operation to 92.20 ±7.82 at 12 months after operation,and 32 patients got excellent results,2 good and 1 moderate. Conclusion：Improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders Ⅲ and Ⅳ calcaneal fractures,which has adv

关 键 词：跟骨 骨折 骨折固定术 内 跗骨 

分 类 号：R687.3[医药卫生—骨科学]