经跗骨窦入路解剖钢板加压骨栓内加压治疗跟骨关节内骨折

目的 观察采用跗骨窦入路解剖钢板加压骨栓内加压治疗跟骨关节内骨折的疗效.方法 选择2006年9月- 2009年5月采用跗骨窦入路解剖钢板加压骨栓内固定治疗的49例(62侧)移位跟骨关节内骨折患者.根据Sanders分型:Ⅱ型39侧,Ⅲ型20侧,Ⅳ型3侧.术前术后均拍摄跟骨侧位、轴位X线片,并行跟骨轴位+后关节面半冠状位+矢状面重建CT检查.观察患者跟骨后关节面及跟骨外形复位情况,测量手术前后跟骨高度、宽度、长度、B(o)hler角及Gissan角.术后12周扶双拐部分负重下地,约16周左右弃拐,于术后8～15个月去除解剖钢板及加压骨栓.采用Maryland后足功能评价标准进行功能评价. 结果 随访7.5 ～23个月,平均10.6个月,无切口感染.患者跟骨后关节面及跟骨外形复位满意,跟骨高度、宽度、长度、B(o)hler角及Gissan角恢复满意,术前术后差异均有统计学意义(P＜0.01).根据Maryland后足功能评价标准:优(90 ～ 100分)29侧,良(80 ～90分)18侧,可(70～ 80分)10侧,差(60 ～70分)5侧.40例(82％)于伤后9.1个月(6.0～12.9个月)重返原工作岗位. 结论 跗骨窦入路解剖钢板加压骨栓内加压是治疗跟骨关节内骨折的一种有效方法.

Internal compression treatment of intra-articular fracture of the calcaneum by anatomical plate with compression bolt through sinus tarsi approach

Objective To observe the curative effect of internal compression in the treatment of intra-articular fracture of the calcaneus by anatomical plate with compression bolt through the sinus tarsi approach.Methods Forty-nine patients with 62 calcaneal fractures treated with anatomical plate with compression bolt through sinus tarsi approach from September 2006 to May 2009 were enrolled in the study.According to Sanders classification,there were 39 patients with type Ⅱ fractures,20 with type Ⅲ fractures and three with type Ⅳ fractures.The axial and lateral view X-ray radiographs and the axial,semi-coronal and sagittal computed tomography (CT) images of the heel were taken before and after operation.The reduction of posterior articular surface of calcaneus and calcaneal shape was observed and the width,height,length,B(o)hler' s angle and Gissan' s angle were measured on the radiographs,respectively.Partial weight bearing was allowed 12 weeks after operation and full weight beating was allowed 16 weeks after operation.The anatomical plates were removed 8-15 months after operation.The Maryland hindfoot score system was applied to evaluate the function of the hindfoot postoperatively.Results All the patients were followed up for 7.5-23 months (average 10.6 months),which showed no wound infection.The reduction of the posterior facet was nearly anatomical (less than 3 mm articular displacement) in all patients and the shape of the calcaneus was satisfactory.The width,height,length,B(o)hler' s angle and Gissan' s angle were improved significantly in all patients (P ＜0.01 ).According to Maryland hindfoot scoring system,29 feet scored 90-100 points (excellent),18 feet scored 80-90 points (good),10 feet scored 70-80 points (moderate) and 5 feet scored 60-70 points (poor).A total of 40 patients (82％) were able to return to their original occupations at mean 9.1 months ( 6.0-12.9 months ) after the injury.Conclusion The anatomical plate with compression bolt internal fixation through sinus tarsi approach is an ideal method for the treatment of displaced intra-articular calcaneus fracture.