Yu Guang-rong, Fan Jian, Zhou Jia-qian, Li Hai-feng, Yang Yun-feng, Huang Yi-gang
Department of Orthopaedics, Tongji University, Shanghai 200065, China.
Zhonghua Wai Ke Za Zhi. 2010 Jun 1;48(11):842-6.
To discuss the characteristics and experience for surgical treatment of combined calcaneal fracture.
Between February 2004 and September 2007, 17 feet of 13 patients with combined calcaneal fractures underwent surgical operations. Among 17 calcaneal fractures, 8 combined with ipsilateral talus fractures, 5 combined with trimalleolar fractures, 4 combined with Pilon fractures. Firstly, fractures of hinder foot were treatment with open reduction and internal fixation according to the principle. Of all, 15 fractures were treated with screws or titanic plate plus open reduction and internal fixation, the rest 2 fractures were treated with subtalar arthrodesis. Postoperative X-ray assessed the internal fixation and union of fractures. The foot function was evaluated by the Maryland Foot Score.
A total of 13 patients were all followed up for 16.0 - 33.0 months (average 26.5 months), superficial infection was found in a patient with open wound 10 d after surgery. All the bone fractures united after surgery from 4 to 6 months. Morphous improvement of the calcaneal were proved by X-ray films and there here was no plates and screws' breakage, loosening. Mild osteoarthritis in Subtalar and ankle joints were found by X-ray after surgery from 9 months to last follow-up. Cystic degeneration and necrosis were found in 5 and 2 cases of talus fractures respectively. According to Maryland Foot Score, excellent was in 3 feet, good in 6 feet, fare in 5 feet and poor in 3 feet, with excellence rate of 52.9%.
Combined calcaneal is a calcaneus-based concomitant ankle and foot fractures after a high-energy injury. Good deal of soft tissue and correct design of operation pre-operatively, restoration of form and power lines of calcaneal, effective bone graft, right place of simple internal fixation or subtalar arthrodesis and good reduction and internal fixation of other fracture in hinder feet intra-operatively and correct function postoperatively are key points to have a relatively satisfied treating effect of combined calcaneal fractures.
探讨跟骨合并骨折的手术治疗特点及经验。
2004年2月至2007年9月，对13例跟骨合并骨折患者的17足行手术治疗。17例跟骨骨折中，合并同侧距骨骨折8例，三踝骨折5例，Pilon骨折4例。首先按原则对后足骨折行切开复位内固定。其中15例骨折采用螺钉或钛板加切开复位内固定，其余2例采用距下关节融合术。术后X线评估内固定及骨折愈合情况。采用马里兰足部评分评估足部功能。
13例患者均获随访，时间16.0～33.0个月（平均26.5个月），1例开放性伤口患者术后10 d出现浅表感染。术后4～6个月所有骨折均愈合。X线片证实跟骨形态改善，无钢板及螺钉断裂、松动。术后9个月至末次随访，X线显示距下关节和踝关节有轻度骨关节炎。距骨骨折分别有5例和2例出现囊性变和坏死。根据马里兰足部评分，优3足，良6足，可5足，差3足，优良率为52.9%。
跟骨合并骨折是高能损伤后以跟骨为基础的踝足部合并骨折。术前充分处理软组织、正确设计手术、恢复跟骨形态及力线、有效植骨、恰当选择单纯内固定或距下关节融合、术中良好复位及固定其他后足骨折以及术后正确功能锻炼是获得跟骨合并骨折相对满意治疗效果的关键。
