手术治疗跟骨关节内骨折.DOCVIP

临床医学论文-手术治疗跟骨关节内骨折 ?????????? 作者：张强，邹德威，海涌，白克文，马华松??? 摘要：目的? 评价切开复位内固定治疗跟骨关节内(距下关节)骨折的早期临床疗效。方法? 本组20 例，26足跟骨骨折。男14 例，女6 例；年龄17～56 岁(平均29.6 岁)。双侧骨折6 例。所有患者术前行跟骨正、侧位及轴位X线摄片；9 例行跟骨CT扫描三维重建。骨折按Paley分型，Ⅰ型(剪力骨折)2足，Ⅱ型(舌型骨折)11足，Ⅲ型(中央塌陷型骨折)6足，Ⅳ型(粉碎型骨折)4足，Ⅴ型(严重粉碎型骨折)3足。所有患者均采用切开复位、Y形跟骨钢板内固定。术后拍X线片，按Maryland足部评分系统评价术后功能。术后平均随访11.4个月(3～24个月)。结果? 术后早期X线片显示26足跟骨骨折都获得了良好复位，根据Maryland足部评分，优12足，良11足，可2足，差1足。结论? 采用切开复位内固定治疗跟骨关节内骨折，可以取得良好的手术效果。 ??? 关键词：跟骨骨折；切开复位内固定；钢板固定 ???? Surgical Treatment for Intraarticular Calcaneal Fractures ??? Abstract： Objective? To evaluated the early clinical effects of open reduction and internal fixation(ORIF) for the treatment of intraarticular(subtalar joint) calcaneal fractures. Methods? 26 feet of 20 patients with intraarticular fractures of the calcaneus were reviewed. Fourteen patients were males and six were females(mean age 29.6 years； range from 17 to 56 years)， and six patients suffered from bilateral fractures. Anteroposterior， lateral， and tangential radiographs were obtained in all patients preoperatively， and 9 patients experienced computed tomography(CT) scans. According to Paley′s classification， there were 2 cases in type Ⅰ， 11 in type Ⅱ， 6 in type Ⅲ， 4 in type Ⅳ and 3 in type Ⅴ. An extensile lateral incision was performed in all patients to provide an anatomic reduction with the use of “Y” shape plates， screws internal fixation. The patients were followed up with an averge time of 11.4 months(range from 3 to 24 months). Results? Radiographs obtained in the early postoperative period showed that complete anatomic reduction were achieved in all 26 feet. According to the Maryland Foot Score， the results were excellent in 9， good in 14， fair in 2， and poor in 1 foot. None of patients required a subsequent operation due to surgery associated causes. Conclusion? The treatment effects of intraarticular calcaneal fractures with ORIF are satsifactory. ??? Key words： calcaneal fracture； open reduction and internal fixation； plate fixation ??? 跟