Abstract
目的 探讨跟骨关节内骨折并脱位的分类与治疗方法. 方法本研究包括 8例患者、 12侧跟骨关节.按照 Sanders系统分类;其中Ⅱ型骨折 2侧,Ⅲ型 4侧,Ⅳ型 6侧.采用切开复位内固定并植骨术,手术切口取标准外侧延长切口,骨折块采用小 AO桥形钢丝板固定,植骨材料采用病人自体髂骨.平均随访时间为 28.6个月( 24～ 33个月),采用 Creighton-Nebraska健康基金会跟骨骨折评分标准评分. 结果Ⅱ型骨折 89.7分,Ⅲ型 86.5分,Ⅳ型 73.5分.切开复位内固定术治疗跟骨骨折较非手术治疗有显著差异 (P 0.05);而在Ⅳ型骨折中,则有显著差异 (P< 0.05). 结论跟骨关节内骨折并脱位宜采用切开复位内固定术,在Ⅳ型骨折中,宜采用植骨术;此有利于早期负重及避免距下关节面塌陷. Sanders'分类系统对临床治疗具有指导意义.
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