目的 分析跟骨关节内骨折早期手术内固定的临床疗效.方法 2001年2月～2005年10月早期(伤后24 h内)采用切开复位、跟骨钛板内固定治疗跟骨关节内骨折24例(28足).骨折按Sanders分型:Ⅱ型3足,Ⅲ型24足,Ⅳ型1足,术后积极进行消肿等综合治疗.结果 所有患者均获随访,随访3～22个月,平均11个月.21例(25足)切口一期愈合,切口皮肤坏死2例2足,切口拆线后裂开1足,均经换药愈合.按Maryland Foot Score评分标准:优16足,良8足,可3足,差1足,优良率85.7%.结论 跟骨关节内骨折早期手术复位、钛板内固定,同时对复位后形成骨缺损较大者行自体骨移植,具有骨折复位满意、可早期进行功能锻炼、患者恢复快、住院费用低等优点.只要掌握好适应证并加强术后处理,可获得满意疗效.

Objective To explore the clinical therapeutic efficacy of interlocking intramedullary nailing with close reduction on the mid-inferior segment fracture of tibia. Methods Totally 46 cases of mid-inferior segment fracture of tibia were treated with unreamed interlocking intramedullary nail with close reduction. After the reduction, the cases of relatively stable fracture were performed dynamic fixation, while those cases of oblique fracture and comminuted fracture were performed early static fixation. Early continuous passive motion (CPM) was prescribed postoperatively for the rehabilitation. Results Forty-two cases were followed up for 6~18 months and their recovery were evaluated according to the Johner and Wruhs criteria for tibia fracture. There were 36 cases of excellent union, 5 cases of good union and 1 case of satisfactory union with an excellent and good union rate of 98%. Conclusion Interlocking intramedullary nailing with close reduction for mid-inferior segment fracture of tibia has advantages of noninvasiveness, less perioperative bleeding, good stability, quick function recovery, high rate of fracture union and less complication.