CAJ | 학술논문

目的评价微创经皮斯氏针撬拨复位空心钉内固定治疗跟骨关节内骨折的疗效.方法回顾性分析2011年11月-2013年6月收治的19例跟骨骨折患者的临床资料.19例患者中SandersⅡ型10例(11足),Ⅲ型7例(7足),Ⅳ型2例(3足).在C形臂X线机下,应用经皮斯氏针撬拨复位加空心钉内固定治疗.测量手术前后B(o)hler角和Gissane角,术后拍摄X线片明确骨折愈合情况.采用美国足踝外科协会(AOFAS)踝与后足评分标准评价患足踝关节功能.结果手术均顺利完成.术后无针道感染和骨折再移位,无螺钉松动、断裂、退出.19例患者均获得随访6～ 20个月,平均11.6个月.骨折全部骨性愈合,愈合时间8～12周,平均10周.术后末次随访时,X线片示跟骨的高度、宽度基本得到恢复,B(o)hler角由术前8.3°±2.1°恢复至术后26.7°±3.2°,Gissane角由术前159.6°±6.4°恢复至术后132.8°±8.1 °;AOFAS踝与后足评分为70～ 100分,平均90.2分,其中优11足、良7足、可3足,优良率85.7％(18/21).结论经皮斯氏针撬拨复位空心螺钉固定术适用于SandersⅡ型、Ⅲ型跟骨骨折,手术微创,固定可靠,简便易行,并发症少,是理想的治疗跟骨关节内骨折的方法之一.
목적 평개미창경피사씨침효발복위공심정내고정치료근골관절내골절적료효.방법 회고성분석2011년11월-2013년6월수치적19례근골골절환자적림상자료.19례환자중SandersⅡ형10례(11족),Ⅲ형7례(7족),Ⅳ형2례(3족).재C형비X선궤하,응용경피사씨침효발복위가공심정내고정치료.측량수술전후B(o)hler각화Gissane각,술후박섭X선편명학골절유합정황.채용미국족과외과협회(AOFAS)과여후족평분표준평개환족과관절공능.결과 수술균순리완성.술후무침도감염화골절재이위,무라정송동、단렬、퇴출.19례환자균획득수방6～ 20개월,평균11.6개월.골절전부골성유합,유합시간8～12주,평균10주.술후말차수방시,X선편시근골적고도、관도기본득도회복,B(o)hler각유술전8.3°±2.1°회복지술후26.7°±3.2°,Gissane각유술전159.6°±6.4°회복지술후132.8°±8.1 °;AOFAS과여후족평분위70～ 100분,평균90.2분,기중우11족、량7족、가3족,우량솔85.7％(18/21).결론 경피사씨침효발복위공심라정고정술괄용우SandersⅡ형、Ⅲ형근골골절,수술미창,고정가고,간편역행,병발증소,시이상적치료근골관절내골절적방법지일.
Objective To evaluate the effect of minimally invasive on intra-articular calcaneal fractures with percutaneous Steinmann's pins poking reduction and cannulate screw fixation.Methods The data of 19 cases (twenty-one feet) with displaced intra-articular calcaneal fractures treated from November 2011 to June 2013 in our trauma centre retrospectively were analyzed.According to Sanders classification,11 feet were type Ⅱ fractures,7 feet were type Ⅲ,and 3 feet were type Ⅳ.Under C-arm imaging guiding,19 cases were treated with percutaneous minimally invasive Steinmann's pins poking reduction and screw fixation.X-rays were taken in the regular follow-up,B(o)hler and Gissane angle were measured.The functional recovery was evaluated by using the American Orthopaedic Foot and Ankle Society (AOFAS) scores.Results Operation were successfully completed.The patients were followed up for 6-20 months (averaged 11.6 months),during which no puncture wound infection,displacement of the fracture fragment occurred.Bone union occurred in all cases with roentgenographic evidence during 8-12 weeks after operation (averaged 10 weeks).The B(o)hler angle of the affected calcaneus was improved to 26.7° ±3.2°,the Gissane angle of the affected calcaneus was returned to 132.8° ±8.1°.The restoration of the height,width was observed on the radiographs.According to AOFAS foot score standard,the effects of 11 feet were excellent,7 were good,and 3 were fair.The excellent and good rate was 85.7％ (18/21).Conclusions Under C-arm imaging guiding,percutaneous minimally invasive Steinmann's pins poking reduction and screw fixation is an optimal choice for the treatment of Sanders type Ⅱ and Ⅲ calcaneal fracture.The procedure is effective,simple,reliable,and minimally invasive with few complications.