摘要
目的 观察个性化设计经跗骨窦切口个性化微创内固定治疗跟骨骨折的临床疗效。方法 回顾性分析自2016-06—2018-02手术治疗的41例Sanders Ⅱ、Ⅲ型跟骨骨折,术前在健侧镜像跟骨三维模型上设计载距突螺钉、跟骨后关节面螺钉、跟骨长轴螺钉的最佳钉道,然后3D打印健侧镜像与患侧跟骨实物模型,进行跟骨微创钢板匹配预弯,用于指导术中操作。结果 41例均获得随访,随访时间7~20个月,平均13.8个月。术后CT显示跟骨后关节面复位Kurozumi评级:优16例,良17例,可8例;跟骰关节面复位Kurozumi评级:优26例,良15例。末次随访时各螺钉置入长度、螺钉与水平面夹角、螺钉与冠状面夹角与术前设计结果比较差异无统计学意义(P>0.05)。末次随访时B?hler角、跟骨高度、跟骨宽度、跟骨内翻角较术前明显改善,差异有统计学意义(P<0.05)。随访期间2例跟骨后关节面复位丢失,未出现深部感染、骨折不愈合、骨折畸形愈合。末次随访踝与后足功能AOFAS评分85~100分,平均92.1分;疼痛VAS评分0~4分,平均1.7分。2例术后出现轻度距下关节炎,活动时出现疼痛,休息并口服止痛药物后疼痛缓解。2例术后出现足外侧缘皮肤麻木不适,均在术后3个月左右恢复正常。结论 个性化设计经跗骨窦切口内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折更加微创、精确、安全,提高了螺钉置入的准确性及跟骨关节面复位质量,降低了术后切口并发症发生率。
Objective To observe the clinical effect of personalized design for minimally invasive internal fixation treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures via tarsal sinus approach.Methods The surgical treatment of 41 cases of Sanders type Ⅱ and Ⅲ calcaneal fracture from June 2016 to February 2018 were retrospectively analyzed.Before operation,the optimal screw trajectory of sustentacular screw(SS),posterior articular surface screw of calcaneal(PASS),long axis screw of calcaneal(LAS)was designed on the three-dimensional model of the mirror model of the contralateral calcaneus.The mirror model of the contralateral calcaneus and the affected calcaneus model were 3D printed,and the minimally invasive steel plate was preshaped to fit the model.They were performed to guide the intraoperative operations.Results All 41 cases were followed up for 7 to 20 months,mean 13.8 months.Postoperative CT evaluated the reduction of articular surface by Kurozumi ratings.The results of posterior articular surface:excellent in 16 cases,good in 17 cases,fair in 8 cases.The results of calcaneal joint surface reduction:Excellent in 26 cases and good in 15 cases.At the last follow-up,there were no statistically significant differences in the length of screws,the Angle between the screws and the horizontal plane,and the Angle between the screws and the coronal plane compared with the preoperative design results(P>0.05).However,the Bohler Angle,calcaneal height,calcaneal width,and calcaneal varus Angle were significantly improved after operation(P<0.05).During the follow-up,2 cases lost the reduction of the posterior articular surface of the calcaneus,but no deep infection,nonunion or malunion occurred.At the last follow-up,the AOFAS score for ankle and hindfoot function ranged from 85 to 100 points,mean 92.1 points.The VAS score for pain ranged from 0 to 4 points,mean 1.7 points.Two cases presented with mild subtalar arthritis after operation and suffered pain during activity.The pain was relieved after rest and with oral analgesics.Two cases suffered numbness and discomfort on the lateral edge of the foot after operation,and both recovered after 3 months.Conclusion The personalized design for minimally invasive internal fixation treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures via tarsal sinus approach is more minimally invasive,accurate and safe.It improves the accuracy of screw placement and the quality of calcaneal articular surface reduction,and reduces the incidence of postoperative incision complications.
作者
汪海清
黄雷
张峰
许文博
姚陆丰
WANG Haiqing;HUANG Lei;ZHANG Feng;XU Wenbo;YAO Lufeng(Department of Foot and Ankle Surgery,Ningbo No.6 Hospital,Ningbo Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Ningbo,Zhejiang 315040,China)
出处
《中国骨与关节损伤杂志》
2025年第10期1038-1043,共6页
Chinese Journal of Bone and Joint Injury
基金
宁波市骨科与运动康复临床医学研究中心(2024L004)
宁波市卫生健康科技计划项目(2023Y64)
宁波市鄞州区科技项目(2021AS0068)。
关键词
SandersⅡ、Ⅲ型跟骨骨折
跗骨窦切口
内固定
微创
3D打印技术
Sanders typeⅡandⅢcalcaneal fracture
Tarsal sinus approach
Internal fixation
Minimally invasive
3D printing technology
