摘要
目的探讨伴有跟骰关节损伤的跟骨骨折的损伤机制、特点和治疗方法。方法1997年2月～2001年4月,71例90足跟骨骨折伴跟骰关节损伤患者,男46例61足,女25例29足;年龄18～67岁,平均38.7岁;左足47足,右足43足。高处坠落伤84足,车祸伤5足,楼梯踏空伤1足。其中12例合并其它损伤,包括8例胸腰椎骨折、1例对侧胫骨pilon骨折、2例股骨干骨折、1例股骨干及肋骨骨折和创伤性休克。根据所摄X线片、CT及跟骰关节面损伤的特点将跟骰关节损伤归纳为四种类型:Ⅰ型46足,占51.1%(46/90);Ⅱ型26足,占28.9%(26/90);Ⅲ型11足,占12.2%(11/90);Ⅳ型7足,占7.8%(7/90)。结果61例78足获得随访,随访时间12～32个月,平均18.4个月。按Maryland足部评分系统评价术后功能:优49足,良25足,可4足;总优良率为94.9%。其中Ⅰ型优良率为100%(41/41),Ⅱ型为95.7%(22/23),Ⅲ型为88.9%(8/9),Ⅳ型为60%(3/5)。结论跟骰关节损伤与跟骨骨折的严重程度有关,在治疗跟骨骨折时应重视跟骰关节的损伤情况及手术固定效果,跟骰关节的损伤程度直接影响跟骨骨折的治疗效果。
Objective To study the mechanism and characteristics of calcaneal fracture involving calcaneocuboid joint and its surgical clinical results. Methods 71 cases with 90 calcaneal fractures accompanied calcaneocuboid joint injury were reviewed in our hospital from February 1997 to April 2001, which included 61 ankles of 46 males and 29 ankles of 25 females with an average age of 38.7 years (range, 18 to 67 years). AP, lateral and axial view X-ray of both feet, broaden view X- ray of the affected foot, and CT scan were taken preoperatively. Among them, 45 ankles were examined with three dimensional reconstruction of CT as well. The calcaneocuboid joint injury were divided into 4 types as follows: typeⅠ(46/90) with one articular fracture line but no displacement; type Ⅱ(26/90) with one articular fracture line accompanied the displacement of fragment and the subluxation of calcaneocuboid joint; type Ⅲ (11/90) with two fracture articular lines, and the displacement of fragment as well as the subluxation of calcaneocuboid joint; and type Ⅳ (7/90) with three articular fracture lines and comminuted fracture or the subluxation of calcaneocuboid joint. Of 71 cases, 63 were operated at 3 to 7 days after injury, and 8 delayed at 10 to 14 days. The incision started at the middle point between the fibula and Achilles tendon proximal to the apex of lateral malleolus, and extended distally to the adjacent part of dorsal and plantar skin, then anterior to the base of fifth metatarsus. After the reduction of fractures, type Ⅰcalcaneal plate, designed by authours, was used for type Ⅰ,Ⅱand Ⅲ fractures, the anterior part of calcaneus was fixed with the vertical wing of plate; type Ⅱ calcaneal plate was used for type Ⅳfractures, the horizontal wing of plate was fixed to cuboid to stabilize the comminuted fragments of anterior calcaneus. Results Of 90 ankles, 78 were followed up for an average of 18.7 months (range, 12 to 32 months). The total excellent and good rate was 94.9% according to Marryland foot score. Furthermore, In type Ⅰ, the excellent and good rate was 100%, type Ⅱ 95.7%, type Ⅲ 88.9% and type Ⅳ 60%. Among the types Ⅳ fracture, 7 ankles obtained satisfied internal fixation, but in 4 of them the plates were broken after weight bearing walking. Conclusion The injury of calcaneocuboid joint is related with the severity of calcaneal fracture, attention should be paid and carried out with reliable internal fixation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第1期15-18,共4页
Chinese Journal of Orthopaedics
