锁定钛板治疗跟骨关节内骨折.docxVIP

锁定钛板治疗跟骨关节内骨折 任耀辉范国勋韩鹏林 (山西汾西矿业集团职工总医院骨科032000) 【摘要】目的：探讨采用锁定钛板治疗跟骨关节内骨折的疗效。方法：对 18例(20足)闭合性跟骨关节内骨折患者采用切开复位锁定钛板内固定治疗。 结果：木组术后18例全部获得随访。所有患者无内固定失败者，骨折均获得骨 性愈合。按照Maryland足部评分系统进行评价，优良率为85%。术后切口皮缘 部分坏死1足，切口感染裂开1足，经换药后愈合；足跟疼痛2足，佩戴足跟垫 后缓解；1足术后并发距下关节创伤性关节炎，距下关节内注射后缓解。结论: 锁定钛板内固定治疗跟骨关节内骨折疗效可靠。 【关键词】锁定钛板；内固定；跟骨关节内骨折 【中图分类号】R687 【文献标识码】A 【文章编号】2095-1752 (2015) 15-0111-02 Treatment of Intra-articular calcaneal fractures by locking titanium plate 【Abstract】Objective To investigate the therapeutic effect of Intra-articular calcaneal fractures by locking titanium plate. Methods 18 patients (20 feet) with in tra-ar ticular calca neal fractures were treated with ope n reduction and in ter fixati on with locking titaniun plate.Results All 18 cases were follow-up. All patients were no failure of internal fixation and achieved?bone?union. According to Maryland foot score system, the excellent and good rate were 85%. The wound margin of 1 foot was partial ?n ecrosis and in fected incisional wound dehisce nee of 1 foot, and healed after dressing change. Heel pain of 2 feet were relieved after wearing the heel pad. 1 foot suffered from subtalar?joint traumatic arthritis after operation, it was relieved after in jection in subtalar?j oin ts.C on elusion In ter fixati on of locki ng tita nium plate is an effective method to treat intra-articular calcaneal fractures. 【Key words] Locki ng tita nium plate; In ter nal fixati on; In tra-articular calca neal fractures 跟骨是最大的附骨，跟骨骨折约占附骨骨折的60%,而关节内移位骨折占 60%?75%⑴,非手术治疗患足功能很难令人满意，造成较高的致残率。随着人 们对跟骨骨折认识的加深以及CT的常规应用，目前切开复位内固定正在得到推 广。自2011.11?2014.1我院采用切开复位锁定钛板内固定治疗跟骨关节内骨折 18例，取得满意疗效。报告如下。 ?资料与方法 1.1 一般资料 本组18例，均为闭合性骨折。其中男15例，女3例；年龄20?57岁，平 均34岁。均为新鲜闭合骨折，单侧16例，双侧2例，合并其他部位骨折4例， 共手术20足。致伤原因：坠落伤14例，车祸伤3例，其他伤1例。手术前常规 患侧跟骨摄侧位、轴位X线片及跟骨CT扫描加三维重建。采用Sanders分型[2], II型9足、III型9足、IV型2足。 1.2手术方法 病例均在伤后7d以后（少于21d）,软组织肿胀消退，特别是张力性水疱重 新上皮化并皮肤皱褶出现后手术⑶。手术前30min应用抗生素。连续硬膜外麻 醉或腰麻，患者侧卧位（双侧同时手术采用俯卧位），上止血带。取跟骨外侧“L” 形切口，纵行切口在跟腱与腓骨之间，横行切口为跖外侧皮肤的连接处并延续到 跟骰关节水平，远端切口略向上。骨膜下锐性分离翻起软