【摘要】 [目的]探讨手术与非手术治疗跟骨骨折的疗效,便于临床选择跟骨骨折的治疗方法。[方法]总结2001年1月~2005年8月间手术治疗的跟骨骨折38例(42足),骨折类型:按Essex-Lopresti分类方法:Ⅰ型,舌形骨折6足,Ⅱ型,压缩骨折28足,Ⅲ型,严重粉碎骨折8足,手术方式均为钢板内固定(AO跟骨钢板,国产仿AO跟骨钢板),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。并与40例(42足)采用非手术方法(手法复位石膏固定、骨牵引后石膏固定)治疗的患者进行比较,所有病例随访10~36个月,平均17个月。[结果]按M aryland足部评分系统评价,并以每足为基数,手术治疗组:优良率93%,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75%。非手术治疗组:优良率67%,其中Ⅰ型骨折优良率为92%,Ⅱ型骨折优良率为77%,Ⅲ型骨折无优良患者。[结论]跟骨骨折治疗的关键是尽可能恢复跟距、跟骰关节面的平整和跟骨的正常解剖形态。对跟骨Essex-Lopresti分类Ⅱ型和Ⅲ型骨折者,应积极采用开放复位内固定治疗,并应恰当地选择手术入路,掌握正确地骨折复位方法和术后处理。对跟骨骨折治疗方式的选择应据患者的个体状况、骨折类型等综合考虑才能达到最佳效果。更多还原

【Abstract】 [Objective]To evaluate the effect of nonoperative and operative treatment in calcaneal fractures.[Method]Operative effect of 38 cases of calcaneal fracture of all kinds(42 foots)were analyzed.Accordind Essex-Loprestis classification,6 foots suffered type I tongue fracture,28 foots suffered compressed fracture(type Ⅱ),8 foots suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction interal fixation by Buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domestically) from the extended "L" lateral approach.Postoperatively,no patient needed plaster fixation.All patients started non-weight-bearing fuctional exercise at 2-3days,gradual weight-bearing walking at 6-8 weeks.The result of operated group was compared with nonoperative treatment group.The follow-up period was from 10 months to 36 months,with an average of 17monthes.[Result]Assessed the effect by Maryland foot score,the base line included every foot.Total excellent and good rate in operative group was 93%,it was 100% in type I fracture group,96% in type Ⅱ fracture group,75% in type Ⅲ fracture group.The result of nonoperative treatment group was:total excellent and good rate was 67%,it was 92% in type I fracture group,77% in type Ⅱ fracture group,there was not excellent and good patients in type Ⅲ fracture group.[Conclusion]It is important to regain the flatness of subtalar joint and calcaneocuboid joint,maintain the normal shape of foot.The authors recommend that type Ⅱ and type Ⅲ fractures of calcaneus according Essex-Loprestis classification were treated with open reduction and interal fixation by Buttress plate.By selecting the appropriate approach,proper reducting and postoperative treating rightly,it is an ideal measure to treat calcaneal fracture by selection of treatment method acciding to patient’s individual status and fracture type.更多还原