微创克氏针撬拨复位空心钉内固定治疗跟骨骨折

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微创克氏针撬拨复位空心钉内固定治疗跟骨骨折[摘要]目的探讨微创经皮克氏针撬拨复位空心钉内固定治疗跟骨骨折的疗效。方法应用经皮克氏针撬拨复位加空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折16例（19足），其中Ⅱ型13例16足，Ⅲ型3例3足。术中侧位透视观察Bohler和Gissane角，Broden位观察后关节面复位情况。围术期常规抗感染。结果16例均得到随访，时间3～15个月，平均（6.3±2.0）个月。骨折愈合时间3.0～4.5个月，平均（3.5±0.3）个月。按照Maryland足部评分：Ⅱ型优14足，良2足；Ⅲ型优1足，良1足，中1足。未见皮缘坏死、腓肠神经损伤，其中Ⅲ型有1足出现针尾皮肤感染（经换药治愈）。结论经皮克氏针撬拨复位加空心钉内固定术，适合于骨折粉碎程度轻、塌陷不严重的跟骨骨折（尤其是SandersⅡ型骨折）、糖尿病患者、下肢血管病变者以及较严重跟骨皮肤挫伤患者，具有术后骨折恢复快、并发症少的优点。[关键词]跟骨骨折；骨折内固定；微创；空心螺钉[中图分类号]R687.3[文献标识码]B[文章编号]1674-4721（2012）07（a）-0217-02Minimallyinvasivetreatmentforcalcaneal4 fractureswithpercutaneouskirschnerwirepokingreductionandcannulatescrewfixationLIHenianYUANZhiwenDepartmentofOrthopaedics,DongguanTraditionalChineseMedicalHospitalinGuandongProvince,Dongguan523005,China[Abstract]ObjectiveToinvestigatetheeffectofminimallyinvasiveforcalcanealfractureswithpercutaneouskirschnerwirepokingreductionandcannulatescrewfixation.MethodsSixteencases(19feet)oftheSandersⅡ,Ⅲcalcanealfractureweretreatedwithpercutaneousminimallyinvasivekirschnerwirepokingreductionandscrewfixation.Amongthem13example16feetwerebelongtosandersⅡ,3cases3feetswerebelongtosandersⅢ.AllofthemwereassessedBohlerandGissaneangleinlateralviewunderfluoroscopicguidance,andthecongruencyoftheposteriorfacetinBrodenviewduringoperation.ResultsThemeanfollow-upperiodwas(6.3±2.0)months(rangefrom3to15months)for16cases.Thefractureswerehealsat3.0to4.5months,averagefor(3.5±0.3)months.4 AllthepatientswereevaluatedbyMarylandfootscore.TheSandersⅡwereexcellentin14feet,goodin2feet,excellentin1foot.Oneasgood,1footasfairinsandersⅢ.Therewasnocomplicationofskinreasonnecrosis,suralnerveneurotrosis.Infectionofneedletailskinoccuredin1caseandcuredaftertradesmedicinecure.ConclusionPercutaneousminimallyinvasivereductionandscrewfixationtechniqueisausefulmethodtotreatcalcanealfractureswithlessseverecomminutedblocksandlesscompressivedegreecases(inparticulartheSandersⅡbonefracture),thediabetes,thepatientswithlowerlimbbloodvesselpathologicalchangeortheseriouscalcaneumskincontusions.Ithasashorteruniontimeandlessmorbiditycomplication,comparedwiththeothermethods.[Keywords]Calcanealfracture;Fracturefixation;Mminimallyinvasive;Cannulatescrew4 跟骨骨折是常见的跗骨骨折，跟骨骨折的治疗目的为恢复距下关节面的凭证和三个关节面的正常解剖关系，恢复根骨的整体外形，恢复Gissane角、Bohler角和后足的负重轴线[1]，临床多采取手术治疗。2009年1月～2011年6月，本院骨科采用微创克氏针撬拨复位空心钉内骨折术治疗跟骨骨折16例（19足），疗效满意。现报道如下：4