周顺利 夏贤生

【摘要】 跟骨骨折是跗骨骨折中最常见的类型，骨折常累及距下关节且常伴有关节面的压缩、塌陷，其解剖复杂，手术技术要求高，加之术后常伴有切口感染、皮肤坏死及功能恢复欠佳等并发症，目前治疗方案仍存在分歧。骨折的分型有利于指导治疗及判断愈后，但跟骨骨折分型较多，本文主要总结临床实际工作中常用的两种分型，用以指导外科治疗实践。近年来有利用3D打印技术辅助治疗跟骨骨折的临床相关报道，并且取得了较好的疗效。本文对以上情况进行综述，希望为治疗跟骨骨折提供一定的参考。

【关键词】 跟骨骨折 骨折分型 外科治疗 3D打印技术

Progress in Surgical Treatment of Calcaneal Fracture/ZHOU Shunli， XIA Xiansheng. //Medical Innovation of China， 2022， 19（16）： -184

[Abstract] Calcaneal fractures are the most common type of tarsal fractures. Fractures often involve the subtalar joints and are often accompanied by compression and collapse of the articular surface. Its anatomy is complex and surgical techniques are highly required. In addition， postoperative complications such as incision infection， skin necrosis and poor functional recovery are often accompanied， there are still differences in current treatment plans. The classification of fractures is conducive to guiding treatment and judging the recovery， but there are many types of calcaneal fractures. This article mainly summarizes the two types commonly used in clinical practice. It is used to guide the practice of surgical treatment. In recent years， there have been clinical reports about the use of 3D printing technology to assist in the treatment of calcaneal fractures， and good results have been achieved. This article reviews the above situation， hoping to provide a certain reference for the treatment of calcaneal fractures.

[Key words] Calcaneal fracture Fracture classification Surgecial treatment 3D printing technique

First-author’s address： Dongguan Eighth People’s Hospital Affiliated to Guangdong Medical University， Dongguan 523000， China

doi：10.3969/j.issn.1674-4985.2022.16.043

跟骨骨折约占人体骨折的2%，占跗骨骨折的60%，75%为累及距下关节的关节内骨折[1];常见于高处坠落伤或直接暴力所致，多伴有跟骨距下关节面压缩坍陷及周围软组织损伤，以及其他部位合并伤[2]。跟骨骨折术前分型较多且手术技术要求高，治疗方案的选择、术后并发症的防治仍存在争议。近年来随着认识的加深及技术的改进新的治疗理念和方法不断进入臨床实践。

1 跟骨的分型

1.1 Essex-Lopresti分型 Essex-Lopresti分型主要是根据跟骨X线侧位片上骨折情况进行分型[3]。Ⅰ型骨折未累及距下关节，包括跟骨体部、粗隆部、结节部以及跟骰关节的骨折;Ⅱ型骨折是骨折线累及距下关节面的骨折，其原发骨折线多经过距下关节内侧部或后半部，根据继发骨折线的走向Ⅱ型骨折又分为舌型骨折和关节塌陷型骨折。……