钛板内固定治疗波及跟距关节跟骨粉碎骨折.docVIP

钛板内固定治疗波及跟距关节跟骨粉碎骨折【摘要】 目的 评价钛板内固定治疗波及跟距关节的跟骨粉碎性骨折的临床疗效。方法 对25例波及跟距关节的跟骨粉碎骨折作切开复位，钛板内固定，术后随访10~28个月，观察骨愈情况及评价术后踝关节功能恢复。结果 所有骨折都能骨性愈合，按margland foot score 系统进行术后功能评价：优15例，良8 例，差2例。术后无伤口感染，合并切口皮缘坏死15例，均能疤痕翕合。 结论 钛板内固定是治疗波及跟距关节的跟骨粉碎骨折的有效方法。 【关键词】 肽板内固定；波及跟距关节；跟骨粉碎骨折 Treatment for comminuted fracture of calcaneus that spreading to articular surfaceby internal fixation with titanium plate HUANG Zhen-qiang，YUAN Yu-yuan，LIANG Li-jian.Wuyi Chinese Medicine Hospital，Jiangmen City，Guangdong Province 529031，China 【Abstract】 Objective To evaluate the outcomes of treatment for comminuted fracture of calcaneus that spreading to articular surfaceby internal fixation with titanium plate Methods 25 patients with comminuted fracture of calcaneus that spreading to articular surface were operated for internal fixation with titanium plate，All the patients were followed up from 10 to 28 months to evaluated the function of calcaneus joint and rate of osseous fusion .Results All the patients can been osseous fixation .The function wre evaluated according to margland foot score ：15 patients wre excellent，8 patients wre good，2 patients wre poor .no wound infectioned .15 patients had necrosis of wound edge.All of them can scar healed.Conclusion Treatment for comminuted fracture of calcaneus that spreading articular surface by internal fixation with titanium plate is an effectivemethod. 【Key words】 Internal fixation with titanium plate；Spreading to articular surface；Comminuted fracture of calcaneus 跟骨骨折较为常见，由于跟骨为内外弓的共同后臂，其形态和位置对弓的形成和负重影响极大。跟骨骨折须做好早期治疗，以免发生病废。波及跟距关节的跟骨粉碎骨折，由于关节面破坏，骨质压缩，常遣有创伤性关节炎，治疗困难。作者自2004-2008对25例波及跟距关节的跟骨粉碎骨折行骨折切开复位，钛板内固定术，效果良好，报告如下。 1 资料与方法 1.1 一般资料 本组男19例，女6例。年龄15~54岁。从高处坠落致伤115例，车祸伤7例，重物砸伤3例。开放性骨折4例，闭合骨折21例。入院最短1 h，最长76 h。所有患者均作重建CT检查，按SANDERS分型；3`型16例，4型9例。 1.2 手术时机 除了4例开放骨折急诊行伤口清创，骨折切开复位，钛板内固定外，其余均待伤后7~10 d待肿胀消退，皮肤张力降低后再行手术治疗。 1.3 手术方法 患者取仰卧位，患侧臀部垫高，患肢驱血后止血带。切口起自外踝上4 cm，向下沿跟骨后上缘及下缘作L形切口，止于腓骨短肌腱止点处，切口位于跟骨外侧皮肤与足底皮肤交界处。小心勿损伤小隐静脉及腓肠神经，沿皮肤切口垂直切至跟骨