张胜林 徐信龙 殷建华 于信成

（金湖县人民医院骨科，江苏淮安 211600）

手术治疗涉及距下关节跟骨骨折的临床体会

张胜林 徐信龙 殷建华 于信成*

（金湖县人民医院骨科，江苏淮安 211600）

背景：对于涉及距下关节的跟骨骨折，由于其骨折类型的复杂性及疗效的不确定性，治疗方法不尽相同。

目的：探讨手术治疗涉及距下关节跟骨骨折的方法及疗效。

方法：回顾性分析2007年7月至2012 年 7月手术治疗的29例32足涉及距下关节跟骨骨折患者的临床疗效。根据Sanders分类：Ⅱ型 9 足，Ⅲ型 19 足，Ⅳ型 4 足。术前行 X 线片及 CT 三维重建测量跟骨高度、宽度、长度，Böhler角及Gissane角，均采取切开复位解剖接骨板内固定治疗。

结果：全 部 获 得 随 防 ，随访时间为 6～20 个月，平均 17.7 个月。术后测量跟骨高度、宽 度 、长度，Böhler角及 Gissane 角均较术前有 明显恢复（P＜0.05）。 根据 Maryland 评分 系统评价：优 17 足 ，良 11 足 ，可 4 足。3 例 3 足于术后 8～10 个月出 现距下关节创伤性关节炎，连续行走 500 m 即出现足部肿痛不适，优良率为 87.5%。

结论：采用改良L型切口切开复位解剖接骨板内固定治疗跟骨骨折可最大程度达到解剖复位，恢复距下关节关系；辅以早期功能锻炼，可取得良好疗效，是治疗严重跟骨骨折的理想方法。

跟骨骨折；内固定；手术治疗；回顾性分析

Background:Calcaneus fracture with subtalar joint collapse is complicated and the therapeutic effect is uncertain.Therefore,there have been many different surgical treatments for it.

Objective:To investigate the outcome of surgical treatment for calcaneus fracture with subtalar joint collapse.

Methods:A total of 29 consecutive patients suffered from calcaneus fracture with subtalar joint collapse and were treated with open reduction and internal fixation with titanium plate in our hospital from July 2007 to July 2012.According to Sanders classification,9 feet were of type Ⅱ,19 feet were of type Ⅲ and 4 feet were of type Ⅳ.Calcaneus height,width,length, Böhler tuber angle and Gissane angle were measured by X-ray imaging and CT three-dimensional reconstruction before and after surgery.

Results:All the patients were followed up from 6 to 20 months with an average of 17.7 months.Height,width,length, Böhler tuber angle and Gissane angle were significantly improved after surgery(P＜0.05).According to Maryland scoring, the end functional result was rated as excellent in 17 feet,good in 11 feet,and fair in feet,with a total satisfactory result(excellent to good)of 87.5%.Three patients experienced traumatic arthritis in 8-10 months after operation.

Conclusions:The surgical treatment of calcaneus fracture with subtalar joint collape that involves open reduction from an extended lateral approach and internal fixation with a calcaneal LCP shows very good preliminary results.It can decrease severe disability and improve the quality of life of the patients.

跟骨骨折多由高处跌落所致，是最常见的跗骨骨折，也是临床常见的复杂骨折之一[1]。跟骨骨折根据骨折线是否涉及距下关节分为关节内骨折和关节外骨折，绝大部分跟骨骨折为关节内骨折，可严重破坏跟距关节和距下关节，导致伤足疼痛及运动功能障碍[2]。……