跟骨骨折的钢板内固定治疗.docVIP

跟骨骨折的钢板内固定治疗 作者：唐三元，杨辉，付海鹰，张宇，詹鹏，林志荣，王旭生 作者单位：暨南大学医学院第三附属医院 珠海市人民医院创伤骨科，广东 珠海 519000 【摘要】 目的 探讨手术治疗跟骨骨折的效果及相关问题。方法 自2001至2004年共手术治疗各型跟骨骨折32 例(34足)，男28 例，女4 例。伤因：坠落伤21 例，车祸伤8 例，其他伤3 例。年龄19～50 岁，平均27.2 岁。合并全身其他骨折13 例。按EssexLopresti分型，Ⅰ型：舌形骨折4足；Ⅱ型：压缩骨折24足；Ⅲ型：严重粉碎骨折6足。均采用切开复位支持钢板(AO跟骨钢板，国产仿AO跟骨钢板)内固定治疗，手术入路均为外侧“L”形扩大入路，术后不用石膏固定，2～3 d后即行不负重功能锻炼，6～8周后逐渐负重锻炼。随访12～34个月，平均16个月。结果 按Maryland足部评分系统评价，并以每足为基数，全组优良率91％，其中Ⅰ型骨折优良率为100％，Ⅱ型骨折优良率为96％，Ⅲ型骨折优良率为67％。有各种并发症包括：跟部增宽、距下关节炎2 例，跟骨骨刺影响行走1 例，手术切口皮缘坏死愈合不良1 例(后经换药而愈)，螺钉后退刺激皮肤不适1 例等。结论 恢复距下关节面及跟骰关节面平整，维持正常足弓形态和跟骨宽度是治疗的重点，恰当地选择手术指征、手术入路，正确地骨折复位和术后处理是治疗的关键，钢板内固定治疗跟骨骨折是一种较理想的方法。 【关键词】 跟骨骨折；钢板内固定；手术治疗；疗效评检；并发症 Operative Treatment of Calcaneal Fractures with the Calcaneal Plate TANG Sanyuan1，YANG Hui1，FU Haiying2，et al (1.Department of Orthopaedics，Zhuhai People′s Hospital，Zhuhai 519000，China；2.Department of Orthopaedics，Zhuhai Gongbei Hospital，Zhuhai 519000，China) Abstract：Objective To evaluate the relative questions and effect of plate for calcaneal fractures.Methods Operatively treatment of 32 cases of calcaneal fracture of all kinds(34 feet).28 cases were male and 4 cases were female injury cause：21 cases suffered drop，8 cases suffered traffic accident，the other was 3 cases.The average age was 27.2 years(19～50 years).13 cases associated with other fractures.According EssexLopresti′s classification，4 feet suffered type I，tongue fracture，24 feet suffered compressed fracture(type Ⅱ)，6 feet suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction and interal fixation by buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domesticaly) from the extended “L” lateral approach.Postoperatively，no patient needed plaster fixation.All patients started nonweightbeating fuctional exercise in 2～3 days，gradual weightbearing walking at 6～8 weeks.The followup period was from 10 monthes to 34 monthes.with an average of 16 monthes.Results Assessed the effect by Ma