摘要
目的探讨开放性跟骨关节内骨折手术治疗的有效方法。方法对GustiloⅡ型以上128例(141足)跟骨关节内骨折,早期解决软组织覆盖及伤口愈合问题,尽量恢复跟骨正常骨性结构,用螺钉或克氏针临时固定骨折,均采用VSD技术治疗为后期处理提供保障,二期根据Sanders分型选择切开复位内固定术或丘部重建距下关节原位融合内固定术。结果所有患者均获随访18~72个月,平均40个月。伤口平均愈合时间16 d,一期愈合率90.8%。浅表感染发生率7.8%,深部感染发生率1.4%,总感染发生率9.2%。足部功能根据AOFAS评分标准评定:优58足,良70足,可10足,差3足,优良率90.8%。结论开放性跟骨关节内骨折的处理应根据伤口损伤和骨折类型不同,采取相应的治疗方法,对较严重跟骨关节内骨折伤采用VSD技术治疗,感染率明显下降,足部功能优良率明显提高。
Objective To investigate effect of surgical treatment for open intraarticular calcaneal fracture. Methods A total of 128 patients （141 feet） with open intraarticular calcaneal fracture combined with severe soft tissue injury were treated, in the early stage of treatment, the primary purposes were to achieve soft tissue coverage for wound healing, and to reduce calcaneal fiacture for avoiding increase of skin tension and contracture of Achilles tendon. In the first stage operation, the fractures were reduced by drawing, prying or manual reduction to restore the width, height and length of calcaneus, and then fixed with screws or IGrschner wires. Finally vacuum sealing drainageOrSD） was used to cover wound according to degree of injury. In the second stage operation, open reduction and internal fLxation or reconstruction of calcaneal thalamus combined with subtalar arthrodesis were used according to Sanders classification. Results All patients were followed up for 18 months to 6 years （average, 40 months）. The average wound healing time was 16 days, and the first rate healing rate was 90.8%. The total infection rate was 9.2%, including superficial infection rate of 7.8% and deep infection rate of 1.4%. According to AOFAS classification, functional recovery was excellent in 58 feet, good in 70 feet, fair in 10 feet and poor in 3 feet, the excellent and good rate was 90.8%. Conclusion For open intraarticular calcaneal fracture combined with severe soft tissue injury, different methods should be used according to degree of injury and fracture style. Usually, the VSD should be used for patients with severe soft tissue injury, which can significantly reduce infection rate and improve effect.
出处
《中国骨与关节损伤杂志》
2013年第8期734-736,共3页
Chinese Journal of Bone and Joint Injury
基金
唐山市科学技术研究与发展计划(11150205A-19)
关键词
跟骨关节内骨折
开放性
VSD
内固定
Intraarticular calcaneal fracture
Open fracture
Vacuum sealing drainage
Internal ivL^ation
