Liang Jun, Xin Jing-yi, Cao Hong-bin
Department of Orthopedics, Tianjin Hospital, China.
Zhonghua Yi Xue Za Zhi. 2012 Jun 5;92(21):1492-4.
To explore the clinical efficacies of displaced intra-calcaneal fractures with operative treatment.
From January 2005 to December 2010, 103 calcaneal patients (92 males, 11 females) were recruited. The mean age was 45.8 years old (range: 23 - 65). All received operative treatment. They included left calcaneal fractures (n = 51), right calcaneal fractures (n = 40) and bilateral calcaneal fractures (n = 12). All patients were of closed fractures. According to the Sanders classification, there were type II (n = 15), type III (n = 75) and type IV (n = 13). A modified lateral approach with profiled plate fixation was adopted for all. Partial weight-bearing occurred at 6 weeks and full weight-bearing at 12 weeks. Function assessment was made with the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS).
The mean follow-up period was 18 months (range: 6 - 30) and the mean healing duration 12 weeks (range: 8 - 15). Two cases had incision dehiscence. After the removal of plate, the skin healed. Eight cases were associated with subtalus arthritis and painful walking. Three cases of caved calcaneal surface appeared after weight-bearing. According to the AOFAS foot score, the outcomes were excellent (n = 83), good (n = 13), fair (n = 5) and poor (n = 2). And the excellent and good rate was 93.2%.
With a modified lateral approach, displaced intra-calcaneal fracture may be treated with a satisfactory clinical efficacy.But an orthopedic surgeon should master skillful surgical techniques.
探讨移位性跟骨骨折手术治疗的临床疗效。
选取2005年1月至2010年12月期间103例跟骨骨折患者(男92例,女11例)。平均年龄45.8岁(范围:23 - 65岁)。均接受手术治疗。其中左侧跟骨骨折51例,右侧跟骨骨折40例,双侧跟骨骨折12例。所有患者均为闭合性骨折。根据Sanders分型,Ⅱ型15例,Ⅲ型75例,Ⅳ型13例。均采用改良外侧入路联合异型钢板固定。6周时部分负重,12周时完全负重。采用美国矫形足踝协会踝 - 后足评分(AOFAS)进行功能评估。
平均随访18个月(范围:6 - 30个月),平均愈合时间12周(范围:8 - 15周)。2例切口裂开,取出钢板后皮肤愈合。8例并发距下关节炎,行走疼痛。3例负重后出现跟骨塌陷。根据AOFAS足部评分,结果为优83例,良13例,可5例,差2例。优良率为93.2%。
采用改良外侧入路治疗移位性跟骨骨折可获得满意的临床疗效。但骨科医生应熟练掌握手术技巧。