摘要
目的探讨切开复位内固定加一期距下关节融合术治疗严重粉碎sandersⅣ型跟骨骨折的疗效。方法回顾性分析2012年6月至2016年12月采用切开复位内固定加一期距下关节融合术治疗的23例严重粉碎SandersⅣ型跟骨骨折患者资料。其中男16例，女7例；年龄32～67岁，平均39．6岁。取自体髂骨植骨融合18例，同种异体骨植骨融合5例。通过测量并比较患者术前、术后、末次随访时的BShler角、Gissane角以评价跟骨解剖形态，采用美国足踝外科协会（AOFAS）的踝。后足评分评价术后功能。结果23例患者术后获6～39个月（平均21个月）随访。手术时间40～100min，平均60min；术中失血量10～40mL，平均20mL。仅有1例患者术后出现切口边缘部分表皮坏死，无一例患者发生感染。骨折愈合和融合时间3～5个月（平均3．5个月），末次随访时距下关节均发生融合，无融合失败病例。术后跟骨解剖形态较术前明显恢复，术前、术后、末次随访时的平均Bohler角分别为12．47°±1．61°、30．58°±5．34°、30．09°±5．78°，术前、术后、末次随访时的平均Gissane角分别为86．21°±7．70°、127．44°±7．61°、129．07°±5．47°，术后、末次随访时的平均Bohler角、Gissane角分别与术前比较差异均有统计学意义（P〈0．05），术后与末次随访时比较差异均无统计学意义（P〉0．05）。末次随访时AOFAS的踝一后足评分：优8例，良11例，可4例，优良率为82．6％。结论切开复位内固定加一期距下关节融合术是治疗SandersIV型跟骨骨折安全、可靠的一种手术方式。
Objective To explore the effects of open reduction and internal fixation plus primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures of Sanders type IV. Methods From January 2012 to December 2016, 23 patients with severely comminuted calcaneal fracture of Sanders type IV were treated by open reduction and internal fixation plus primary subtalar arthrodesis at our department. They were 16 men and 7 women with an average age of 39.6 years （range, from 32 to 67 years）. Auto-iliac bone graft was performed in 18 cases and allo-bone graft in the other 5 cases. BShler and Gissane angles were measured preoperatively, postoperatively and at the last follow-up to evaluate anatomical mor- phology of the calcaneus; the American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score was used to evaluate the functional recovery. Results All the 23 cases were followed up successfully for an average time of 21 months （range, from 6 to 39 months）. The operations lasted from 40 to 100 minutes with an average of 60 minutes; the intraoperative bleeding ranged from 10 to 40 mL with an average of 20 mL. No one suffered from wound infection but partial epidermal necrosis happened in only one case. Union and fusion of the fractures was achieved after 3 to 5 months with an average of 3.5 months. At the last follow-up, no failed fusion of the subtalar joint happened. Anatomical morphology of the calcaneus was improved obviously. The Bohler angles were respectively 12. 47° ±1.61°, 30.58° ± 5.34°and 30. 09°±5.78° preoperatively, postoperatively and at the last follow-up; the Gissane angles were respectively 86.21° ±7.70°, 127.44°± 7.61° and 129. 07°± 5.47° preoperatively, postoperatively and at the last follow-up. There were significant differences between preoperation versus postoperation and the last follow-up in the above 2 values （P 〈 0, 05） ; there were no significant differences between postoperation and the last follow-up in the above 2 values （ P 〉 0.
出处
《中华创伤骨科杂志》
CSCD
北大核心
2017年第12期1046-1051,共6页
Chinese Journal of Orthopaedic Trauma
基金
四川省卫生和计划生育委员会科研课题（16PJ549）
西南医科大学科研课题（20130440）
西南医科大学附属医院科研课题（15049）
关键词
跟骨骨折
骨折固定术
内
关节融合术
植骨
Calcaneal fracture
Fracture fixation, internal
Arthrodesis
Bone graft
