摘要
目的 观察采用一期彻底清创、经伤口复位、克氏针经皮穿距下关节内固定的方法治疗GustiloⅡ、ⅢA型开放性跟骨骨折的疗效.方法 自2009年5月至2012年10月手术治疗开放性跟骨骨折19例,男17例,女2例;年龄31 ～ 60岁,平均39.6岁;骨折按Gustilo分型：Ⅱ型8例,ⅢA型11例;按Sanders分型：Ⅱ型3例,Ⅲ型12例,Ⅳ型4例.将跟骨内侧伤口一期彻底清创,经伤口复位,然后采用克氏针经皮穿距下关节进行内固定.伤口均不一期缝合,待伤口肉芽组织充填后二期游离植皮覆盖创面,必要时行腓肠神经营养皮瓣转移充填软组织缺损.测量并比较手术前、后跟骨B（o）hler角、Gissane角、高度、宽度.结果 所有患者术后随访14～ 26个月（平均16.8个月）.5例患者发生浅表感染经换药后治愈,无皮肤坏死、深部感染、骨不连、骨髓炎等并发症或截肢.12例患者解剖复位,7例患者接近解剖复位.所有患者的跟骨B（o）hler角、Gissane角、跟骨高度、跟骨宽度恢复满意,与术前比较差异均有统计学意义（P＜0.05）.术后1年采用美国足踝外科协会踝与后足评分评估疗效：优9例,良7例,可2例,差1例.结论 一期彻底清创、经伤口复位、克氏针经皮穿距下关节内固定是治疗GustiloⅡ、ⅢA型开放性跟骨骨折的一种有效方法.
Objective To assess the operative treatment of open calcaneal fractures of Gustilo types Ⅱ and Ⅲ A by urgent debridement,reduction through the open wound,immediate fixation by percutaneous transarticular k-wire and delayed wound closure.Methods From May 2009 to October 2012,19 cases of open calcaneal fractures were treated according to the same operative protocol.They were 17 men and 2 women,aged from 31 to 60 years （average,39.6 years）.By Gustilo classification,8 cases were of type Ⅱ and 11 of type ⅢA.By Sanders classification,there were 3 cases of type Ⅱ,12 ones of type Ⅲ and 4 ones of type Ⅳ.After intravenous administration of antibiotics,urgent debridement and reduction through the open wound under the C-arm inspection,the sinus tarsi approach was used when necessary.Percutaneous K-wire fixation was conducted through the posterior facet,and the wound was left open or covered with VSD.The soft tissue coverage was delayed until application of a split-thickness skin graft or pedicle flap transfer.Before and after operation,axial and lateral X-ray radiography and axial,semi-coronal and sagittal CT of the heel were performed.The width,height,B（o）hler＇s angle and Gissane＆#39;s angle were compared between preoperation and postoperation.Clinical results were graded according to the AOFAS （American Orthopaedic Foot and Ankle Society） scoring one year postoperation.Results All the 19 patients were available for an average follow-up of 16.8 months （from 14 to 26 months）.Superficial infection occurred in 5 patients but was cured after dressing change.No skin necrosis,deep infection,bone nonunion,osteomyelitis or amputation occurred.Reduction of the posterior facet was graded as anatomical in 12 cases and as nearly anatomical in 7 cases.The width,height,B（o）hler＇s and Gissane＇s angles were improved significantly in all patients （P 〈 0.05）.By the AOFAS ankle-hindfoot scores,9 cases were excellent,7 good,2 moderate and one poor.Conclusion The surgical protocol of urgent debridement,reduction through the open wound,immediate fixation by percutaneous transarticular k-wire and delayed wound closure is an ideal treatment of open calcaneal fractures of Gustilo types Ⅱ and Ⅲ A.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第6期480-485,共6页
Chinese Journal of Orthopaedic Trauma
关键词
跟骨
骨折
开放性
骨折固定术
内
Calcaneus
Fractures,open
Fractures fixation,internal
