撬拨复位接骨板内固定治疗跟骨关节内粉碎性骨折

摘要

目的：总结撬拨复位接骨板内固定治疗跟骨关节内粉碎性骨折的临床疗效。方法回顾性分析自2008年1月至2014年1月采用切开撬拨复位接骨板内固定治疗68例77足跟骨关节内粉碎性骨折的临床资料。男47例，女21例，年龄18~70岁，平均39.8岁。骨折按 Essex-Lopresti 分型，压缩型Ⅱ度49足，Ⅲ度4足，舌型Ⅱ度19足，Ⅲ度5足。77足均采用跟骨外侧改良“L”形切口，切开撬拨复位，跟骨接骨板内固定。定期随访观察骨折愈合及并发症。结果77足复位固定良好，3足皮缘坏死，切口迟缓愈合。本组患者获得1~6年，平均1.5年随访，骨折均愈合，骨性愈合时间4~7个月，平均5.6个月。末次随访采用 Mrayland Foot Sore 足部评分标准评价手术疗效，优21足，良43足，可9足，差4足，优良率83.1％，接骨板无松动、移位与折断。结论采用撬拨复位距下关节及恢复跟距关节间隙，并以 Gissane 角及 Böhler 角为标准，恢复跟骨的长、宽、高度，纠正跟骨内外翻畸形，辅以跟骨接骨板固定是治疗跟骨关节内粉碎性骨折的有效方法。%Objective To summarize the clinical efficacy of levering reduction and internal fixation for intra-articular comminuted calcaneal fractures. Methods From January 2008 to January 2014,seventy-seven feet with intra-article comminu-ted calcaneal frature were operated by the mean of levering reduction and internal fixation,they were 47 men and 21 women, with the age of 18 to 70 years old(average,39. 8 years). According to Essex-Lopresti's classification,49 feet were compres-sion-type Ⅱ and 4 feet were Ⅲ,9 feet were tongue-type Ⅱ and feet were Ⅲ. All patients were treated with levering reduction by the Kirschner wire(the function of the kirschner wire was similar to a level in the operation)and internal fixation with the calcaneal plate via the modified L-shape lateral approach,the bone healing and complications were followed up regularly. Re-sults All of the seventy-seven feet showed excellent results of reduction and fixation,but there were 3 feet who occurred the skin flap necrosis and slow healing of the incision. The patients were followed up for 1 to 6 years(average 1. 5 years),all of them healed in 4 to 7 months(average 5. 6 months). The operational efficacy was assessed by Mrayland Foot scoring system at the last follow-up. Mrayland foot scoring system showed excellent functional recovery in 21 feet,good in 43 feet,fair in 9 feet, and poor in 4 feet,giving an excellence to good rate of 83. 1% ,no plate loosening,shifting or broken occurred. Conclusion With the standard of Gissane and boholer angle,levering reduction the subtalar joint and maintaining the distance of calcaneus and astragalus,recovering the length、width and height of the calcaneus,modifying the varus and valgus deformity,and fixing the bone with the calcaneal plate at last is an efficient method to treat the displaced intra-anticular comminuted calcaneal frac-ture.