闭合复位联合小切口钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折

摘要

Objective To investigate the effect of Sanders typeⅡ,Ⅲcalcaneal fractures treated with closed reduction and internal plate fixation by small incision. Methods The 26 patients with Sanders typeⅡ,Ⅲ closed calcaneal fractures were treated by colsed reduction and plate fixation through small incision. Postoperative imaging examination was used to observe the fracture reduction, fixation and fracture healing situation, and AOFAS ankle-behind foot sco-ring criteria was used to assess the postoperative efficacy. Results All the patients were followed up for 6 ～20 (12.6±2.4) months. Bone union was achieved at 8～12 (10.7±3.8) weeks. There was no delayed incision heal-ing, internal fixation loosening, rupture, no fracture malunion and traumatic arthritis and other complications after surgery. Due to poor drainage, one of Sanders typeⅢexperienced incision subcutaneous effusion,and the wound was cured on schedule after the local treatment. At the final follow-up, the B?hler angle increased significantly from pre-operative 7.2°±3.5° to 25.1°±6.2°, while the Gissane angle improved from preoperative 89.6°±2.1° to 113.7°± 4.9° ,the differences were statistically significant (P＜0.05). The AOFAS scoring of ankle-behind at the last follow-up: 16 cases were rated as excellent,7 as good and 3 as fair. Conclusions Closed reduction and calcane-al bone plate internal fixation by small incision is an effective treatment for Sanders type Ⅱ and Ⅲ calcaneal frac-tures, with less trauma and fewer incision complications,which content the requirement of reduction and internal fixa-tion for Sanders type Ⅱ,Ⅲ calcaneal fractures.%目的 探讨闭合复位联合小切口钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效.方法 采用闭合复位联合小切口钢板内固定治疗26例SandersⅡ、Ⅲ型跟骨骨折患者.术后行影像学检查观察骨折复位、固定及愈合情况,采用AOFAS踝-后足评分标准评定疗效.结果 患者均获得随访,时间6～20(12.6±2.4)个月.骨折愈合时间8～12 (10.7±3.8) 周,未发生切口延迟愈合、内固定物松动或断裂、骨折畸形愈合及创伤性关节炎等并发症. 1例Sanders Ⅲ 型患者因术后引流不畅出现切口皮下积液,经局部治疗后伤口按期治愈.末次随访时,B?hler 角由术前7.2°±3.5°改善为25.1°±6.2°,Gissane 角由术前89.6°±2.1°改善为113.7°±4.9°,差异均有统计学意义(P＜0.05).末次随访AOFAS踝-后足评分:优16例,良7例,可3例.结论 闭合复位联合小切口跟骨接骨钢板内固定创伤小,切口并发症少,能够满足SandersⅡ、Ⅲ型跟骨骨折术中复位及内固定要求.