手术治疗累及距下关节跟骨骨折11例体会.DOCVIP

临床医学论文-手术治疗累及距下关节跟骨骨折11例体会 ????????? 作者：刘烈斌，陈强，赵家安，曾宪明，卓春芳 【摘要】? 目的? 分析跟骨关节内骨折手术复位及人工骨植骨的方法及疗效，提高临床治愈率。方法? 随访2001年8月～2004年2月采用切开复位加Y形钢板内固定伴必要时人工骨植骨治疗的SandersⅡ～Ⅳ型跟骨骨折11例11足，其中Ⅱ型1足，Ⅲ型9足，Ⅳ型1足。术中直视下复位Bohler角及跟骨后关节面。骨缺损处以人工骨颗粒填塞，Y型钢板固定跟骨，伤口负压引流，围手术期抗生素应用。术后随访8～36个月，平均14个月。结果? 采用张铁良跟骨骨折评分方法，评价效果优7足，良2足，可2足，优良率为81.8%；早期伤口皮缘坏死4足，发生率占36.4%；远期并发症为行走疼痛。结论? Y型钢板加人工骨植骨治疗累及距下关节面的跟骨骨折疗效确切，但须注意切口皮瓣保护以及引流通畅彻底。 　　【关键词】? 跟骨；骨折；骨折内固定；人工骨植骨?? 　　Experience on surgical treatment for 11 cases of calcaneal fracture involved subtalar joint 　　【Abstract】? Objective? To analyze the method and curative effect of intrajoint fracture of calcaneus treated with diaplasis by operation and implant man-made bone and to enhance the rate of clinical cure rate.Methods? Follow up 11 cases with 11 feet of calcaneal fracture of Sanders Ⅱ-Ⅳ type,(one case Sanders Ⅱ,nine cases Sanders Ⅲ,one case sanders Ⅳ),that treated with open reduction and fixation with Y plate and implant man-made bone when necessary from August 2001 to February 2004.Redude Bohler angle and the post-joint surface of calcaneus by direct watching in operation.Implant man-made bone where the bone is lack, fix calcaneus with Y plate,the incision use drainage by negative pressure,and use antibiotic in peri-operation. After operation follow up 8 months to 36 months, average period of 14 months.Results?According to Zhang Tieliang calcaneal fracture rating system,7 cases effect was excellent, 2 cases good,2 cases fair.The excellent and good rate was 81.8%; 4 cases occurred necrosis of the skin of the edge of the incision in early period,the rate was 36.4%;future subsequent symptom was pain when walking.Conclusion?The curative effect of calcaneal fracture that involved the subtalar joint surface treated by fixation with Y plate and implanting man-made bone is certain,but must pay attention to protect the flap of the incision and drainage smoothly and to the core. 　　【Key words】? calcaneus;fracture;internal fixation of fracture;man-made bone imp