切开复位内固定治疗跟骨移位关节内骨折的效果观察

摘要

Objective To make a retrospective analysis of the outcome and prognosis of open reduction and internal fixation in the treatment of displaced intra-articular calcaneal fractures. Methods From January 2007 to January 2010, 38 patients with displaced intra-articular calcaneal fractures treated by open reduction and plates fixation were identified. 24 of males and 14 of females patients were included in this study. All patients had special plates fixation through a lateral approach. All cases were followed up for at least 2 years , with radiologic check-up by X-ray and CT imaging. Clinical results were evaluated by American orthopedic foot and ankle society hindfoot scale (AOFAS), foot function index (FFI), 10-scale visual analogue scores (VAS). Results A total of 38 patients were included, consisting of 17 of sanders type Ⅱ and 21 of sanders type Ⅲ fractures. Preoperative Bohler's angle was -24 -33 , with an average of (13.2 8.9) , which recovered to 20 -45 , with an average of (33.8 9.2) . No significant difference was found between groups based on sanders type or age (all P > 0.05), however, better results were obtained in anatomic reduction and iliac autografts group for AOFAS, FFI and VAS, as compared with patients who did not have anatomic reduction or iliac autograft (all P < 0.05). Conclusion The results of this study demonstrate that mid-term prognosis of displaced intra-articular calcaneal fracture is correlated significantly with individual features of cases, degree of anatomic reduction of subtalar joint and recovery of Bohler's angle, while no correlation with sex and fractures type.%目的 回顾性分析切开复位内固定手术治疗跟骨移位关节内骨折的疗效及预后.方法 2007年1月～2010年1月,筛选接受切开复位钢板内固定手术治疗的跟骨移位关节内骨折患者38例,其中,男24例,女14例,手术均应用跟骨外侧切口,切开复位异型钢板内固定术,术后随访2年以上,定期进行X线和CT检查.采用美国足踝外科学会评分(AOFAS)、足功能指数(FFI)、10 cm可视量表评估(VAS)行足踝功能评分.结果 共有38例患者进入回顾性研究,17例为Sanders Ⅱ型骨折,21例为Sanders Ⅲ型骨折.术前测量Bohler角为-24°～33°,平均(13.2±8.9)°,术后恢复为20°～45°,平均(33.8±9.2)°.在不同Sanders分型和性别组,AOFAS、FFI、VAS评分差异均无统计学意义(均P ＞ 0.05),而解剖学复位组和植骨组患者较近似解剖学复位和未进行植骨组的患者,AOFAS、FFI、VAS评分获得明显的改善(均P ＜ 0.05).结论 切开复位内固定治疗跟骨移位关节内骨折的中期预后与所选病例的特征、距下关节面的解剖学复位、Bohler角的恢复相关,与患者的性别、Sanders分型无关.