手术治疗跟骨关节内骨折的疗效分析(1)
【摘要】目的探讨跟骨关节内骨折的手术治疗。方法2007年3月~2010年12月，对20例26足跟骨关节内骨折采用开放复位钢板内固定治疗，男14例，女6例；年龄18～39岁，平均28岁。骨折按照Sanders分型：Ⅱ型(8足)、Ⅲ型(13足)、Ⅳ型(5足)行开放复位H型钢板内固定，复位后跟骨后关节面骨质缺损明显者取自体髂骨植骨。结果本组3例4足失访，其他患者获得8～37个月(平均10个月)随访。跟结节角由术前10.3°±5.8°恢复至术后39.2°±2.3°，跟骨体-丘部高度由术前(37.2±3.0) mm恢复至术后(43.8±2.0) mm，差异均有统计学意义(跟结节角t=23.317，P=0.000；跟骨体-丘部高度t=8.669，P=0.000)。术后6个月X线片示骨折全部骨性愈合，术后X线片未见明显骨关节炎征象。依据Kerr术后评定标准：优15足，良6足，可1足，优良率95%。结论开放复位钢板固定治疗跟骨骨折充分恢复了跟结节角、距下关节面的平整，维持相关动力装置的正常张力，消除了位移骨折块对软组织的不良刺激。
【关键词】跟骨；关节内；骨折；骨折固定术
, http://www.100md.com
Surgical treatment of calcaneal intra-articular fractures efficacy analysis LIANG Ding-tian,HAN Bi-yuan.The Peoples Hospital of Nanao in Shenzhei City,Shenzhen 518121,China
【Abstract】ObjectiveTo explore surgical treatment of calcaneal intra-articular fractures. MethodsMarch 2007 to December 2010 total 20 cases with 26 feet of calcaneal fractures used open reduction plate fixation(14 cases of men,four were women)；Age 18-39,average 28 years old. Fracture Sanders points type:type Ⅱ(8 feet),type Ⅲ(13 feet), type Ⅳ(5 feet).Used open reset H plate fixation after the reset heel bone articular surface bone defect obvious,grafted from autogenous iliac.Results Among 3 cases 4 foot lost to follow-up, other patients get 8-37 months (mean 10 months) follow-up.Calcaneal nodules Angle before surgery “10.3°±5.8°”return to“ 39.2°±2.3°”after surgery.From Calcaneal body to Calcaneal thalamus height is (37.2±3.0)mm before surgery return to postoperative (43.8±2.0)mm ，difference was statistically significant (Calcaneal nodules Angle t = 23.317, P= 0.000; From Calcaneal body to Calcaneal thalamus height t=8.669，P= 0.000).Six months after surgery of X-ray film has showed all of calcaneal fractures bony healed, Did not see obvious osteoarthritis pine.Kerr postoperative evaluation standard:Optimal 15 feet;6 feet were good; 1 feet was slightly worse.For 95%dykes.Conclusion Open reduction steel plate fixation for calcaneal fractures fully recovered calcaneal nodules Angle、fully recovered under the flatness of talus joints，maintained the relevant power device of normal tension, the displacement of fracture block act on the soft tissue produces undesirable stimulation can be eliminated.
, 百拇医药
【Key words】Calcaneal;Intra-articular;Fracture;Fracture fixation
在跟骨骨折中波及后关节面的骨折占75%，非手术治疗此型骨折疗效差，遗留严重的功能残疾。随着手术方法及辅助检查手段的改进，切开复位钢板内固定治疗波及距下关节的跟骨骨折取得良好的疗效。自2007年3月~2010年12月采用切口复位钛板内固定治疗20例波及距下关节的跟骨骨折患者，疗效显著，报告如下。
1资料与方法
1.1一般资料本组20例26足，男14例，女6例；年龄18～39岁，平均28岁。受伤机制：高处坠落伤跟部着地17例，交通伤直接撞击跟部2例，爆炸伤1例。双侧跟骨骨折7例。开放伤3例3足均为Gustilo-Anderson分型Ⅱ型，闭合伤17例23足。合并脊柱及下肢等部位损伤9例。所有病例均行跟骨侧位、轴位X线片、CT检查及健侧侧位、轴位X线片[1]。骨折根据Sanders分型[2]：Ⅱ型8足，Ⅲ型13足，Ⅳ型5足。
, 百拇医药
1.2手术方法患者取仰卧位，采用全身麻醉或硬膜外麻醉，采用Regazzoni[3]和Benische[4]推荐的扩大跟骨外侧入路。逐层切开，直到跟骨外侧壁，紧贴跟骨外侧壁锐性掀开组织瓣，术中无需游离显露腓肠神经，把腓肠神经及腓骨长短肌腱保留在组织瓣内。撬开跟骨外侧壁，切断跟腓韧带并将足内翻，切除距跟后关节所有残余的关节囊和骨膜组织，可见后关节面骨折块向前下方旋转移位，用剥离器将后关节面骨块撬起与距骨关节面匹配，自足底穿克氏针将该骨块与距骨固定。跟骨结节处置放克氏针牵引帮助复位结节处骨折，恢复跟结节角，并用克氏针临时固定，侧方挤压纠正跟骨体部侧方移位及成角。C型臂X线机透视跟骨，侧位显示距下关节骨折块与距骨关节面匹配良好，结节骨块位置满意，跟结节角基本恢复正常，轴位显示跟骨骨折无成角及分离。骨缺损2 cm2以上的取自体髂骨植骨，复位外侧壁骨折块。跟骨钛板螺钉固定，针尾剪短留于皮外，保留至术后1个月。伤口置胶片引流。, 百拇医药(梁鼎天 韩碧园)
【关键词】跟骨；关节内；骨折；骨折固定术
, http://www.100md.com
Surgical treatment of calcaneal intra-articular fractures efficacy analysis LIANG Ding-tian,HAN Bi-yuan.The Peoples Hospital of Nanao in Shenzhei City,Shenzhen 518121,China
【Abstract】ObjectiveTo explore surgical treatment of calcaneal intra-articular fractures. MethodsMarch 2007 to December 2010 total 20 cases with 26 feet of calcaneal fractures used open reduction plate fixation(14 cases of men,four were women)；Age 18-39,average 28 years old. Fracture Sanders points type:type Ⅱ(8 feet),type Ⅲ(13 feet), type Ⅳ(5 feet).Used open reset H plate fixation after the reset heel bone articular surface bone defect obvious,grafted from autogenous iliac.Results Among 3 cases 4 foot lost to follow-up, other patients get 8-37 months (mean 10 months) follow-up.Calcaneal nodules Angle before surgery “10.3°±5.8°”return to“ 39.2°±2.3°”after surgery.From Calcaneal body to Calcaneal thalamus height is (37.2±3.0)mm before surgery return to postoperative (43.8±2.0)mm ，difference was statistically significant (Calcaneal nodules Angle t = 23.317, P= 0.000; From Calcaneal body to Calcaneal thalamus height t=8.669，P= 0.000).Six months after surgery of X-ray film has showed all of calcaneal fractures bony healed, Did not see obvious osteoarthritis pine.Kerr postoperative evaluation standard:Optimal 15 feet;6 feet were good; 1 feet was slightly worse.For 95%dykes.Conclusion Open reduction steel plate fixation for calcaneal fractures fully recovered calcaneal nodules Angle、fully recovered under the flatness of talus joints，maintained the relevant power device of normal tension, the displacement of fracture block act on the soft tissue produces undesirable stimulation can be eliminated.
, 百拇医药
【Key words】Calcaneal;Intra-articular;Fracture;Fracture fixation
在跟骨骨折中波及后关节面的骨折占75%，非手术治疗此型骨折疗效差，遗留严重的功能残疾。随着手术方法及辅助检查手段的改进，切开复位钢板内固定治疗波及距下关节的跟骨骨折取得良好的疗效。自2007年3月~2010年12月采用切口复位钛板内固定治疗20例波及距下关节的跟骨骨折患者，疗效显著，报告如下。
1资料与方法
1.1一般资料本组20例26足，男14例，女6例；年龄18～39岁，平均28岁。受伤机制：高处坠落伤跟部着地17例，交通伤直接撞击跟部2例，爆炸伤1例。双侧跟骨骨折7例。开放伤3例3足均为Gustilo-Anderson分型Ⅱ型，闭合伤17例23足。合并脊柱及下肢等部位损伤9例。所有病例均行跟骨侧位、轴位X线片、CT检查及健侧侧位、轴位X线片[1]。骨折根据Sanders分型[2]：Ⅱ型8足，Ⅲ型13足，Ⅳ型5足。
, 百拇医药
1.2手术方法患者取仰卧位，采用全身麻醉或硬膜外麻醉，采用Regazzoni[3]和Benische[4]推荐的扩大跟骨外侧入路。逐层切开，直到跟骨外侧壁，紧贴跟骨外侧壁锐性掀开组织瓣，术中无需游离显露腓肠神经，把腓肠神经及腓骨长短肌腱保留在组织瓣内。撬开跟骨外侧壁，切断跟腓韧带并将足内翻，切除距跟后关节所有残余的关节囊和骨膜组织，可见后关节面骨折块向前下方旋转移位，用剥离器将后关节面骨块撬起与距骨关节面匹配，自足底穿克氏针将该骨块与距骨固定。跟骨结节处置放克氏针牵引帮助复位结节处骨折，恢复跟结节角，并用克氏针临时固定，侧方挤压纠正跟骨体部侧方移位及成角。C型臂X线机透视跟骨，侧位显示距下关节骨折块与距骨关节面匹配良好，结节骨块位置满意，跟结节角基本恢复正常，轴位显示跟骨骨折无成角及分离。骨缺损2 cm2以上的取自体髂骨植骨，复位外侧壁骨折块。跟骨钛板螺钉固定，针尾剪短留于皮外，保留至术后1个月。伤口置胶片引流。, 百拇医药(梁鼎天 韩碧园)