手术治疗累及距下关节跟骨骨折11例体会
跟骨,,跟骨；骨折；骨折内固定；人工骨植骨,1资料与方法,2结果,3讨论,4结论,【参考文献】
【摘要】 目的 分析跟骨关节内骨折手术复位及人工骨植骨的方法及疗效，提高临床治愈率。方法 随访2001年8月～2004年2月采用切开复位加Y形钢板内固定伴必要时人工骨植骨治疗的SandersⅡ～Ⅳ型跟骨骨折11例11足，其中Ⅱ型1足，Ⅲ型9足，Ⅳ型1足。术中直视下复位Bohler角及跟骨后关节面。骨缺损处以人工骨颗粒填塞，Y型钢板固定跟骨，伤口负压引流，围手术期抗生素应用。术后随访8～36个月，平均14个月。结果 采用张铁良跟骨骨折评分方法，评价效果优7足，良2足，可2足，优良率为81.8%；早期伤口皮缘坏死4足，发生率占36.4%；远期并发症为行走疼痛。结论 Y型钢板加人工骨植骨治疗累及距下关节面的跟骨骨折疗效确切，但须注意切口皮瓣保护以及引流通畅彻底。【关键词】 跟骨；骨折；骨折内固定；人工骨植骨
Experience on surgical treatment for 11 cases of calcaneal fracture involved subtalar joint
LIU Lie-bin,CHEN Qiang,ZHAO Jia-an,et al.
Torch Development Zone Hospital,Zhongshan 528437,China
【Abstract】 Objective To analyze the method and curative effect of intrajoint fracture of calcaneus treated with diaplasis by operation and implant man-made bone and to enhance the rate of clinical cure rate.Methods Follow up 11 cases with 11 feet of calcaneal fracture of Sanders Ⅱ-Ⅳ type,(one case Sanders Ⅱ,nine cases Sanders Ⅲ,one case sanders Ⅳ),that treated with open reduction and fixation with Y plate and implant man-made bone when necessary from August 2001 to February 2004.Redude Bohler angle and the post-joint surface of calcaneus by direct watching in operation.Implant man-made bone where the bone is lack, fix calcaneus with Y plate,the incision use drainage by negative pressure,and use antibiotic in peri-operation. After operation follow up 8 months to 36 months, average period of 14 months.Results According to Zhang Tieliang calcaneal fracture rating system,7 cases effect was excellent, 2 cases good,2 cases fair.The excellent and good rate was 81.8%; 4 cases occurred necrosis of the skin of the edge of the incision in early period,the rate was 36.4%;future subsequent symptom was pain when walking.Conclusion The curative effect of calcaneal fracture that involved the subtalar joint surface treated by fixation with Y plate and implanting man-made bone is certain,but must pay attention to protect the flap of the incision and drainage smoothly and to the core. ......
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