摘要
目的 评价闭合复位经皮空心螺钉内固定治疗Sanders Ⅱ型、Ⅲ型跟骨骨折的临床疗效.方法 2008年1月至2011年9月采用闭合复位经皮空心螺钉治疗跟骨骨折患者25 例28足.其中男19 例,女6 例;年龄20～65 岁,平均37.8 岁.术前均行跟骨轴位、侧位X线检查,并进行CT平扫加重建.根据Sanders分型,Ⅱ型19足,Ⅲ型9足.术后根据美国足踝外科学会踝-后足评分标准评定功能情况.结果 术后25 例均获得8～18个月随访,平均11.2个月,术后伤口感染3足,2足浅表感染,1足深部感染,所有跟骨后关节面和跟骨长度、宽度、高度均恢复满意,无内固定物并发症发生.骨折于术后9～16周愈合,平均10.6周.随访期间后关节面均无塌陷发生,X线片示Bhler角和Gissane角、跟骨外形基本恢复正常.按照美国踝足外科学会踝-后足评分标准进行评价,优16足（57.14%）,良9足（32.14%）,差3足（10.71%）,平均88.7分,优良率89.29%.3足术后发生创伤性关节炎.结论 闭合复位经皮空心螺钉内固定治疗Sanders Ⅱ型、Ⅲ型跟骨骨折具有操作简单、创伤微小、固定牢靠、并发症少、术后恢复快、疗效佳等优点,也适合治疗软组织挫伤严重、切开复位内固定禁忌的跟骨骨折患者.
Objective To evaluate the results of the treatment of Sanders Ⅱ、Ⅲ Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation. Methods From January 2008 to September 2011,25 cases （28 feet） of Sanders Ⅱ、ⅢCalcaneal Fractures were treated with Closed Reduction and Percutaneous Screw Fixations, 19 were males and 6 were females, aged 20 to 65 years （37.8 years on average）. 19 patients were type Ⅱ ang were type Ⅲ by Sanders classification respectively. Postoperative infections were recorded. During follow-up, pain, functional outcome, range of motion, and change in footwear were evaluated with the use of the American Orthopaedic Foot ＆ Ankle Society （AOFAS） score. Results We reviewed the cases of 25 patients who had a combined total of 28 displaced intra-articular calcaneal fractures and a follow-up period of 8 to 18 months （mean I I. 2 months）. Three wound infections occurred ,two of which were superficial and one of which was deep. All cases showed clinical healing during 9 to 16 weeks （ mean 10. 6 weeks ）. There were no failure of internal fixationin. The Bohler＇s, Gissane＇s angle, calcaneal width and height were reduced close to normal anatomic structure in X-ray. According to AOFAS Hindfoo score, the operation results were excellent in 16 feet, good in 9, and poor in 3. The AOFAS Hindfoot Score av- eraged 88.7. The overall satisfactory results （ excellent and good） were 89.29%. At the time of follow-up, subtalar arthrodesis had been performed in three patients. Conclusion Percutaneous screw fixation of calcaneal fractures（ Sanders lI ,ll[ ） is asso- ciated with minimal soft tissue traumatization and low complication rates, It allows early rehabilitation and excellent results with proper patient selection. The procedure is suitable for most types of intra-articular fractures especially in patients with compro- mised soft tissues in which open reduction and internal fixation is contraindicated.
出处
《实用骨科杂志》
2013年第9期800-803,共4页
Journal of Practical Orthopaedics
基金
浙江省科技厅公益性计划项目(2011C33024)
浙江省自然基金计划项目(Y2110653)
关键词
跟骨骨折
空心螺钉
内固定
calcaneal fractures
cannulated screw
internal fixation
