【摘要】 目的：探讨跟骨关节内骨折钛钢板内固定治疗的疗效及减少并发症的策略。方法：47例52侧跟骨关节内骨折采用外侧扩大“L”型切口使用跟骨钛钢板固定并对术后并发症进行分析。结果：47例52侧跟骨关节内骨折经随访6～36 个月, 平均17个月，按Maryland评分,优良率为86.5%。Bhler角由术前平均5度(-10度～15度)恢复到术后平均28度(5度～45度)，随访中有2例后关节面发生塌陷，Bhler角5度，行走严重疼痛。切口坏死 2 例 ,切口感染 1 例 ,无腓肠神经损伤。 并发症发生率9.6%。结论：跟骨关节内骨折采用钛钢板内固定，术中掌握复位和固定的关键点，正确选择手术时机和切口无创操作对 Sanders 2、3型骨折能取得满意的疗效。
【关键词】 跟骨 骨折 内固定器 外科手术
Titanic alloy plate internal fixation for intracalaneal joint fracture and prevention of complication
ZHANG Huixuan, ZHANG Jun, CAI Zhixian
(Department of Orthopedics, Dongkeng Hospital of Dongguan City, Dongguan 523451,China)
[ABSTRACT] Objective: To explore titanic alloy plate internal fixation for intracalaneal joint fracture and prevention of complication. Methods: Fiftytwo patients with intracalaneal joint fracture were treated with titanic alloy plate internal fixation through external incision of expanded “L” pattern and the results were analyzed. Results: Fiftytwo patients underwent the operation were followup 6～36 months, mean 17 months, assessed with Maryland Scale, satisfactory rate was 86.5%, angle of Bhler recovered from average 5°(-10°～15°)before treatment to average 28°(5°～45°)after the operation; 2 cases occurred posterior joint face collapse, the angle of Bhler was 5°,patients felt severe pain when walking. 2 cases occurred necrosis of incision, 1 case occurred infection of incision, none occurred gastrocnemius nerve lesion. The incidence of complication was 9.6%. Conclusion: Titanic alloy plate internal fixation for intracalaneal joint fracture of SandersⅡ,Ⅲ has high effect and little complication; the keys to success are to command indication, practice mininvasive incision, proper reduction and fixation.
[KEY WORDS] Calaneal bone; Fracture; Internal fixation appliance; Surgical procedures, operative
跟骨是重要的承载骨，跟骨骨折是最常见的跗骨骨折, 占跗骨骨折的60%，约75%为关节内骨折,传统采用手法复位、撬拨复位石膏外固定或克氏针内固定治疗, 但效果不甚满意, 功能障碍明显。2002 年2 月～2007 年2 月,我科行切开复位跟骨钛
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