摘要
背景:微创治疗跟骨骨折渐成趋势,通过跗骨窦入路空心螺钉内固定治疗SandersⅡ型跟骨骨折的方法和疗效值得探讨。目的:探讨跗骨窦入路空心螺钉内固定治疗跟骨SandersⅡ型骨折的手术方法和临床疗效。方法:采用跗骨窦入路经载距突空心螺钉内固定治疗35例跟骨骨折患者,男21例,女14例;年龄23~58岁,平均(45.4±6.9)岁;左侧23例,右侧12例;骨折按Sanders分型:ⅡA型17例,ⅡB型18例。测量记录患者术前术后B?hler角和Gissane角,观察关节面的恢复情况。按照美国足踝外科协会Maryland足部评分标准评价足部功能恢复效果。结果:本组患者均获得随访,随访时间6~12个月,平均(9.5±1.9)个月。骨折均愈合,愈合时间8~12周,平均(9.8±1.5)周。无切口并发症发生。B?hler角术前平均15.2°±2.6°,术后平均30.7°±3.2°;Gissane角术前平均95.9°±4.0°,术后平均125.2°±11.6°,手术前后比较差异均有统计学意义(P<0.05)。按Maryland足部评分系统进行功能评定:优24例,良9例,可2例,优良率为94.3%。结论:跗骨窦入路经载距突空心螺钉内固定治疗跟骨SandersⅡ型骨折,组织剥离少,可以很好地恢复跟距关节面平整,跟骨的宽度、B?hler角及Gissane角均得到良好的恢复,值得临床推广应用。
Background： Minimally invasive treatment of calcaneal fractures is becoming popular. Objective： To explore the surgical technique and clinical effect of cannulated screw internal fixation via the tarsal sinus approach for type Ⅱ Sanders fracture of the calcaneus. Methods： Totally 35 patients with calcaneal fracture treated by the sustentaculum cannulated screw fixation through the sinus tarsi approach were enrolled in this study. There were 21 males and 14 females with a mean age of （45.4±6.9） years （range, 23-58 years）. There were 17 cases of type Ⅱ A and 18 cases of type ⅡB according to Sand- ers classification. The Bohler and Gissane angles were measured before and after the operation. The articular surface was ob- served during follow-up. The foot functional recovery was evaluated according to the Maryland foot score standard of the American foot and ankle surgery association. Results： All the patients were followed up for 6-12 months with a mean dura- tion of （9.5± 1.9） months. All the fractures healed, and the mean healing time was （9.8± 1.5） weeks （range, 8-12 weeks）. No incision-related complications were found. B6hler angle （15.2° ±2.6° vs 30.7°± 3.2°） and Gissane angle （95.9° ±4.0° vs 125.2°± 11.6°） were significantly increased after surgery as compared with preoperative ones （P〈0.05）. The excellent and good rate was 94.3% （excellent in 24 cases, good in 9, and fair in 2） according to the Maryland foot scoring system. Conclu- sions： The talocalcaneal articular surface, the width of the calcaneus, B6hler angle and Gissane angle can be restored well af- ter cannulated screw fixation through the sinus tarsi approach in patients with type Ⅱ Sanders fracture of the calcaneus. It is worthy of clinical application.
作者
梁伟之
高金伟
张海波
付磊
魏世隽
LIANG Weizhi;GAO Jinwei;ZHANG Haibo;FU Lei;WEI Shijun(Department of Orthopedics, Shanxi Armed Police Forces Hospital, Taiyuan 030006;Department of Orthopedics, Wuhan General Hospital of Guangzhou Military Area, Wuhan 430060, China)
出处
《中华骨与关节外科杂志》
2018年第2期111-114,共4页
Chinese Journal of Bone and Joint Surgery
关键词
跟骨
骨折
外科手术
微创性
Calcaneus
Fractures, Bone
Surgical Procedures, Minimally Invasive
