摘要
目的：评价切开复住跟骨钢板内固定治疗跟骨关节内骨折的疗效。分析手术治疗方法相关因素和存在的问题。寻找预防及处理方法。方法：在C型臂监控下，采样跟骨外侧延长“L”形切口入路对35例跟骨关节内骨折进行切开复位钢板内固定治疗。根据手术前后X线片对跟骨高度、宽度、长度及跟骨Bohler角和Gissane＇s角进行评估，并观察术后切口愈合情况，采用Maryland足评分系统评价临床功能疗效。结果：所有患者术后获得随访5。24个月，x线片显示术后跟骨高度、宽度、长度及跟骨Bohler角和Gissane＇s均获得满意恢复，Maryland足部评分系统显示优20例，良10例，可5例，优良率85．7％。术后早期出现切口裂开、坏死及感染共5例，占总病例数14．2％。结论：切开复位跟骨钢板内固定是治疗跟骨关节内移位骨折较理想的方法。具有复位好、固定可靠、功能恢复满意等优点。跟骨后关节面的良好复位和恢复跟骨的匝常形态是恢复跟骨良好功能的关键。而手术时机、操作规范、技术熟练程度等综合治疗效果也有一定影响，严格掌握手术适应证、规范操作流程、熟练的手术技巧是预防和减少手术并发症关键。
Objective： To discuss the clinical therapeutic effects following open reduction and internal fixation （ORIF） of displaced intra-articular calcaneal fractures, to analyze related factors concerning the surgical treatment and its problems, and to look for prevention and treatment methods. Methods： thirty-five articular calcaneal fractures were treated with ORIF via extensile L-shaped approach to the calcaneus under the monitoring of C-arm x-ray.Pre- and postoperative radiographs were evaluated to detect caleaneal anatomical parameters including height, width, length, B？hler angle and Gissane angle. The lateral wound healing was observed and clinical functional outcomes were graded using the Maryland foot score. Results： All patients were followed up ranging from 5 to 24 months. Lateral roentgenograms showed satisfactory restoration of the calcaneal height, width, length, B？hler angle and Gissane. Maryland foot score demonstrated excellent results in 20 feet, good in 10, fair in 5. The excellent and good rate was 85.7%.Wound complications, such as early post-operative incision dehiscence, necrosis, and infection, were found in 5 fractured feet （14.2%）. Conclusion： ORIF is an effective method for the treatment of displaced intra-articular calcaneal fractures. It has the advantages of producing good reduction for dislocation, good fixation and satisfactory functional recovery. Good reset of calcaneal articular surface and restoration of calcaneal morphology are the key to restoration of the normal ealcaneal function .Other factors, such as the surgical time, operating norms, and the technical proficiency can also influence treatment results. Strict observance of surgical indications, standardization of the operation process, and the skilled surgical technique are the key to preventing and reducing post-operative complications.
出处
《安徽卫生职业技术学院学报》
2009年第4期24-25,共2页
Journal of Anhui Health Vocational & Technical College
关键词
跟骨
关节内骨折
手术疗效
并发症
calcaneus
intra-articular fractures
surgical effects
complications
