【摘要】 目的探讨手术治疗跟骨骨折的效果及相关问题。方法自2001至2004年共手术治疗各型跟骨骨折32例(34足),男28例,女4例。伤因:坠落伤21例,车祸伤8例,其他伤3例。年龄19~50岁,平均27.2岁。合并全身其他骨折13例。按E ssex-Lopresti分型,Ⅰ型:舌形骨折4足;Ⅱ型:压缩骨折24足;Ⅲ型:严重粉碎骨折6足。均采用切开复位支持钢板(AO跟骨钢板,国产仿AO跟骨钢板)内固定治疗,手术入路均为外侧"L"形扩大入路,术后不用石膏固定,2~3 d后即行不负重功能锻炼,6~8周后逐渐负重锻炼。随访12~34个月,平均16个月。结果按M ary land足部评分系统评价,并以每足为基数,全组优良率91%,其中Ⅰ型骨折优良率为100%,Ⅱ型骨折优良率为96%,Ⅲ型骨折优良率为67%。有各种并发症包括:跟部增宽、距下关节炎2例,跟骨骨刺影响行走1例,手术切口皮缘坏死愈合不良1例(后经换药而愈),螺钉后退刺激皮肤不适1例等。结论恢复距下关节面及跟骰关节面平整,维持正常足弓形态和跟骨宽度是治疗的重点,恰当地选择手术指征、手术入路,正确地骨折复位和术后处理是治疗的关键,钢板内固定治疗跟骨骨折是一种较理想的方法。更多还原

【Abstract】 Objective To evaluate the relative questions and effect of plate for calcaneal fractures.Methods Operatively treatment of 32 cases of calcaneal fracture of all kinds(34 feet).28 cases were male and 4 cases were female injury cause:21 cases suffered drop,8 cases suffered traffic accident,the other was 3 cases.The average age was 27.2 years(19～50 years).13 cases associated with other fractures.According Essex-Lopresti′s classification,4 feet suffered type I,tongue fracture,24 feet suffered compressed fracture(type Ⅱ),6 feet suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction and interal fixation by buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domesticaly) from the extended "L" lateral approach.Postoperatively,no patient needed plaster fixation.All patients started non-weight-beating fuctional exercise in 2～3 days,gradual weight-bearing walking at 6～8 weeks.The follow-up period was from 10 monthes to 34 monthes.with an average of 16 monthes.Results Assessed the effect by Maryland foot score,the base line included every foot.The total excellent and good rate was 91%,it was 100%in type Ⅰ fracture group,96%in type Ⅱ fracture group,67% in type Ⅲ fracture group.The complication included:2 cases suffered heel extend and subtalar joint arthritis,1 case suffered calcaneal bone spur affecting walk.1 case suffered apical wound necrosis and poor union(cured by exchanging dressing lately).1 case suffered uncomfortable by the backoff screw stimulating skin.Conclusion It is important to regain the flatness of subtalar joint and calcaneocuboid joint,maintain the normal shape of foot arc and the width of calcaneum.By selecting the surgry sign and approach correctly,reducting and postoperative treating rightly,it is an ideal measure to treat calcaneal fracture by plate imemalfixation.更多还原