切开复位异形钢板内固定治疗跟骨骨折临床疗效.docVIP

切开复位异形钢板内固定治疗跟骨骨折临床疗效【摘要】 目的 探讨切开复位异型钢板内固定治疗跟骨骨折的临床效果。方法 本组患者17例21足，均行切开复位异形钢板内固定,自体髂骨移植11足，人工骨移植5足。分别于术后1、3、6个月和1 年分别摄片观测骨愈合的情况和Bohler 角恢复情况。根据AOFAS足踝功能评分标准，末次随访时评定足部功能。结果 所有病例随访时间为12～33个月，平均21个月。评测足部功能，优13 足，良5足，可3足，优良率达86%。早期并发症其中切口皮缘坏死3足，中期并发症距下关节创伤性关节炎2例。结论 粉碎性跟骨骨折，选择适当的手术时机，采用全厚皮瓣，避免术中过分牵拉，术后充分引流并抬高患肢可有效减少并发症生。? 【关键词】 跟骨骨折；内固定；骨折并发症 ?? Plate fixation for calcaneus fractures and prevention of complications XU Yong?xu.The First Peoples Hospital of Tancheng Country in Shandong Province,Shandong 276100,China ? 【Abstract】 Objective To discuss the clinical outcome of internal fixation with plate for calcaneal fractures and prevention of complications.Methods Open reduction and internal fixation with plate combined with bone graft was performed on 17 cases (21 calcareus) with calcaneal fractures.Observed the restoration of Bohler?s angle by radiography after 6 weeks and 1 year. All patients were followed up for an average of 21 month s (from 12 to 33 months). Results The results were excellent in 13 cases, good in 5 cases and fair in 3 cases. The rate of excellent and good was 86%. The early postoperative complications were 3 cases necrosis of the skin incision margin, The later complication was posttraumatic osteoarthritis of posterior subtalar joint in 2 cases. Conclusion The main objective in treating calcaneal fractures is to restore mechanics of the calcaneus. The preoperative assessment of soft tissue injuries is also very important as well as complications reducing.? 【Key words】 Calcaneal fracture; Internal fixation; Fracture complications ? 作者单位：276100山东省郯城县第一人民医院 跟骨骨折占跗骨骨折60%1?3］，所有骨折的2%，关节内骨折占所有跟骨骨折的70%。其累及的人群主要为20～40岁，约占90%。同其他关节内骨折一样，处理棘手。手术治疗早期有可能发生腓肠神经损伤、切口皮瓣坏死、切口血肿及感染等并发症。我院从2006年1月至2008年3月,对17例(21足)跟骨关节内骨折行切开复位钢板内固定术，治疗结果如下。? 1 临床资料? 本组17例(21足),男10例,女7例;左足6例,右足7例,双足4例。年龄19～53岁，平均33.4岁。坠落伤13例，砸伤4例，均为闭合骨折，合并胸腰段压缩骨折3例，内踝骨折1例。SandersⅡ型骨折10足，Ⅲ型7足，IV型4足,受伤至手术时间最短6 h，最长10 d，平均6.3 d。均采用异型跟骨钢板固定,自体髂骨移植11足，人工骨移植5足。多数