摘要
目的探讨跟骨关节内骨折并脱位的分类与治疗方法。方法本研究包括8例患者、12侧跟骨关节。按照Sanders系统分类;其中Ⅱ型骨折2侧,Ⅲ型4侧,Ⅳ型6侧。采用切开复位内固定并植骨术,手术切口取标准外侧延长切口,骨折块采用小AO桥形钢丝板固定,植骨材料采用病人自体髂骨。平均随访时间为28.6个月(24～33个月),采用Creighton-Nebraska健康基金会跟骨骨折评分标准评分。结果Ⅱ型骨折89.7分,Ⅲ型86.5分,Ⅳ型73.5分。切开复位内固定术治疗跟骨骨折较非手术治疗有显著差异(P<0.05),在Ⅱ、Ⅲ型骨折中,术中采用植骨与否,无显著差异(P>0.05);而在Ⅳ型骨折中,则有显著差异(P<0.05)。结论跟骨关节内骨折并脱位宜采用切开复位内固定术,在Ⅳ型骨折中,宜采用植骨术;此有利于早期负重及避免距下关节面塌陷。Sanders'分类系统对临床治疗具有指导意义。
Objective To investigate the classification and treatment of displaced intra articular fractures of the calcaneus. Methods Twelve displaced intra articular fractures of the calcaneus in 8 patients were included in this study. Classification of calcaneus fractures was done according to Sanders' computed tomographic classification system. There were 2 cases of type Ⅱfractures, 4 type Ⅲfractures and 6 type Ⅳfractures. The open reduction and internal fixation (ORIF) and bone grafting were performed using a standard extended lateral approach, and the fractures were fixed with small fragment AO bridge plates with autogenous bone grafting. Average follow up was 28.6 months (range 24 to 33 months). The Creighton Nebraska Health Foundation Assessment Score System for fractures of the calcaneus was used for evaluation. Results The average score was 89.7 for type Ⅱ, 86.5 for type Ⅲ, and 73.5 for type Ⅳfractures. There was statistically significant superiority in treatment by ORIF compared with nonoperative methods (P< 0.05). In type Ⅱand type Ⅲfractures, there were no significant differences between ORIF combined with bone grafting and that without bone grafting (P >0.05); whereas in type Ⅳfractures, the differences were significant between with and without bone grafting (P< 0.05). Conclusions We recommend that displaced intra articular fractures of the calcaneus be treated with ORIF combined with bone grafting in type Ⅳfractures, because it has the advantages of preventing subtalar joint collapse and early weight bearing. Sanders' classification system can guide the treatment of calcaneal fractures.
出处
《中华创伤骨科杂志》
CAS
CSCD
2004年第3期273-275,共3页
Chinese Journal of Orthopaedic Trauma
关键词
切开复位
内固定
植骨术
跟骨
关节内骨折
关节移位
适应证
Calcaneal fracture
Operative treatment
Fracture fixation,internal
Bone trensplantation
Joint shift
