I.T.S.鎖定鋼板治療跟骨關節內骨折的近期療效_《中國修復重建外科雜志》

作者：

吳俊國 ¹ , 柴益民 ² , 董有海 ¹ , 顧文奇 ² , 黃漢偉 ¹ , 姜海瑩 ¹ , 陳諫 ¹ , 陳旭君 ¹ , 錢光 ¹ , 黃沛彥 ¹

1復旦大學附屬上海第五人民醫院骨科（上海，200240）;;
2上海交通大學附屬第六人民醫院骨科;

關鍵詞：

跟骨關節內骨折 I.T.S.鎖定鋼板切開復位內固定

DOI：

10.7507/1002-1892.20130231

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目的總結I.T.S.鎖定鋼板治療跟骨關節內骨折的近期療效。方法 2010年7月－2011年7月，收治18例跟骨關節內閉合骨折患者。其中男10例，女8例；年齡25～64歲，平均46歲。骨折按Sanders分型：Ⅱ型3例，Ⅲ型9例，Ⅳ型6例。受傷至手術時間5～11 d，平均6 d。待軟組織條件改善后，行經外側L形擴大切口切開復位I.T.S.鎖定鋼板內固定。結果術后1例患者出現切口淺表感染，經換藥后愈合；其余患者切口均Ⅰ期愈合。16例獲隨訪，隨訪時間12～18個月，平均14個月。X線片示骨折均愈合，愈合時間10～14周，平均12周。隨訪期間無內固定失效、腓骨肌腱激惹等并發癥發生。1例術后11個月X線片示距下關節炎，伴輕度疼痛，給予保守治療后癥狀明顯緩解。末次隨訪時，B ouml;hler角從術前（12.9 ± 3.2）°增加至（33.8 ± 4.0）°，差異有統計學意義（t=22.78，P=0.00）；Gissane角從術前（83.6 ± 6.4）°增加至（119.9 ± 8.5）°，差異有統計學意義（t=17.02，P=0.00）；美國矯形足踝協會（AOFAS）踝與后足評分系統評分為（80.3 ± 7.9）分，疼痛視覺模擬評分（VAS）為（1.3 ± 1.2）分。結論采用I.T.S.鎖定鋼板治療跟骨關節內骨折，可獲得骨折端的穩定固定，近期療效滿意。

引用本文： 吳俊國,柴益民,董有海,顧文奇,黃漢偉,姜海瑩,陳諫,陳旭君,錢光,黃沛彥. I.T.S.鎖定鋼板治療跟骨關節內骨折的近期療效. 中國修復重建外科雜志, 2013, 27(9): 1057-1060. doi: 10.7507/1002-1892.20130231 復制

1.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
2.	蔣協遠, 王大偉. 骨科臨床療效評價標準. 北京: 人民衛生出版社, 2005: 231-233.
3.	Schon LC, Wisbeck JM. Minimally invasive plate fixation of calcaneus fractures. Tech Orthop, 2012, 27(2): 118-125.
4.	Goldzak M, Mittlmeier T, Simon P. Locked nailing for the treatment of displaced articular fractures of the calcaneus: description of a new procedure with calcanail(?). Eur J Orthop Surg Traumatol, 2012, 22(4): 345-349.
5.	Hyer CF, Atway S, Berlet GC, et al. Early weight bearing of calcaneal fractures fixated with locked plates: a radiographic review. Foot Ankle Spec, 2010, 3(6): 320-323.
6.	Richter M, Gosling T, Zech S, et al. A comparison of plates with and without locking screws in a calcaneal fracture model. Foot Ankle Int, 2005, 26(4): 309-319.
7.	Illert T, Rammelt S, Drewes T, et al. Stability of locking and non-locking plates in an osteoporotic calcaneal fracture model. Foot Ankle Int, 2011, 32(3): 307-313.
8.	Stoffel K, Booth G, Rohrl SM, et al. A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. Clin Biomech (Bristol, Avon), 2007, 22(1): 100-105.
9.	ten Broeke RH, Alves A, Baumann A, et al. Bone reaction to a biomimetic third-generation hydroxyapatite coating and new surface treatment for the Symax hip stem. J Bone Joint Surg (Br), 2011, 93(6): 760-768.
10.	SooHoo NF, Farng E, Krenek L, et al. Complication rates following operative treatment of calcaneus fractures. Foot Ankle Surg, 2011, 17(4): 233-238.
11.	Buckley R, Tough S, McCormack R, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg (Am), 2002, 84-A(10): 1733-1744.
12.	Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. Int Orthop, 2011, 35(5): 697-703.
13.	Woon CY, Chong KW, Yeo W, et al. Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures: the best of both worlds. J Trauma, 2011, 71(4): 917-925.
14.	Kissel CG, Husain ZS, Cottom JM, et al. Early clinical and radiographic outcomes after treatment of displaced intra-articular calcaneal fractures using delta-frame external fixator construct. J Foot Ankle Surg, 2011, 50(2): 135-140.
15.	施忠民, 顧文奇, 蔣垚. 微創鎖定板內固定治療跟骨關節內骨折. 中華創傷骨科雜志, 2012, 14(8): 648-653.
16.	Femino JE, Vaseenon T, Levin DA, et al. Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: the limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery. Iowa Orthop J, 2010, 30: 161-167.

1. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
2. 蔣協遠, 王大偉. 骨科臨床療效評價標準. 北京: 人民衛生出版社, 2005: 231-233.
3. Schon LC, Wisbeck JM. Minimally invasive plate fixation of calcaneus fractures. Tech Orthop, 2012, 27(2): 118-125.
4. Goldzak M, Mittlmeier T, Simon P. Locked nailing for the treatment of displaced articular fractures of the calcaneus: description of a new procedure with calcanail(?). Eur J Orthop Surg Traumatol, 2012, 22(4): 345-349.
5. Hyer CF, Atway S, Berlet GC, et al. Early weight bearing of calcaneal fractures fixated with locked plates: a radiographic review. Foot Ankle Spec, 2010, 3(6): 320-323.
6. Richter M, Gosling T, Zech S, et al. A comparison of plates with and without locking screws in a calcaneal fracture model. Foot Ankle Int, 2005, 26(4): 309-319.
7. Illert T, Rammelt S, Drewes T, et al. Stability of locking and non-locking plates in an osteoporotic calcaneal fracture model. Foot Ankle Int, 2011, 32(3): 307-313.
8. Stoffel K, Booth G, Rohrl SM, et al. A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. Clin Biomech (Bristol, Avon), 2007, 22(1): 100-105.
9. ten Broeke RH, Alves A, Baumann A, et al. Bone reaction to a biomimetic third-generation hydroxyapatite coating and new surface treatment for the Symax hip stem. J Bone Joint Surg (Br), 2011, 93(6): 760-768.
10. SooHoo NF, Farng E, Krenek L, et al. Complication rates following operative treatment of calcaneus fractures. Foot Ankle Surg, 2011, 17(4): 233-238.
11. Buckley R, Tough S, McCormack R, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg (Am), 2002, 84-A(10): 1733-1744.
12. Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. Int Orthop, 2011, 35(5): 697-703.
13. Woon CY, Chong KW, Yeo W, et al. Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures: the best of both worlds. J Trauma, 2011, 71(4): 917-925.
14. Kissel CG, Husain ZS, Cottom JM, et al. Early clinical and radiographic outcomes after treatment of displaced intra-articular calcaneal fractures using delta-frame external fixator construct. J Foot Ankle Surg, 2011, 50(2): 135-140.
15. 施忠民, 顧文奇, 蔣垚. 微創鎖定板內固定治療跟骨關節內骨折. 中華創傷骨科雜志, 2012, 14(8): 648-653.
16. Femino JE, Vaseenon T, Levin DA, et al. Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: the limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery. Iowa Orthop J, 2010, 30: 161-167.

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I.T.S.鎖定鋼板治療跟骨關節內骨折的近期療效

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