跗骨窦切口钢板内固定联合经皮置钉技术微创治疗Sanders Ⅱ、Ⅲ型跟骨骨折
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摘要
目的探讨跗骨窦切口钢板内固定联合经皮置钉技术微创治疗Sanders II、Ⅲ型跟骨骨折的临床疗效。方法回顾性分析2016年5月至2017年12月采用跗骨窦切口钢板内固定联合经皮置钉技术微创治疗并获得随访的23例病例资料。其中,Sanders II型15例,SandersⅢ型8例;男15例,女8例;年龄22～61岁,平均年龄44.2岁。记录术后软组织情况,测量跟骨术前、术后及随访X线片的B?hler角、Gissane角、骨折复位情况及骨折愈合时间,对测量数据采用SPSS 20.0软件进行统计学分析,并于末次随访时按照Maryland足部评分系统进行评分。结果经过10～13个月(平均11.8个月)随访。术后所有跟骨均达到解剖复位或近乎解剖复位,且均无切口边缘皮肤坏死、血肿形成。骨折全部愈合,愈合时间3～6个月,平均4.4个月。术后B?hler、Gissane角与术前比较差异有统计学意义(<0.01)。根据Maryland评分,优13例,良8例,可2例,优良率为91.3%。2例有腓肠神经损伤表现。结论跗骨窦切口钢板内固定联合经皮置钉术具有创伤小、切口并发症少、复位固定可靠的优点,可用于治疗Sanders II、Ⅲ型跟骨骨折,临床疗效满意。
Objective To investigate the clinical effects of the sinus tarsi approach and plate fixation with minimal-invasive percutaneous pedicle screw technology in treating calcaneal fractures of Sanders type II&III. Methods From May 2016 to December 2017, 23 patients with calcaneal fractures(Sanders type II&III) were treated with minimal-invasive percutaneous pedicle screw using the sinus tarsi approach and plate fixation. There were 15 males and 8 females with age ranging from 22 to 61 years(mean, 44.2 years). According to the classification of Sanders, 15 case were classified as type II, and eight as type III.The soft tissue condition after operation was recorded. Fracture reduction and healing time were measured. Record and compare the B?hler angle and Gissane angle before and after operation. Maryland foot score system was used to evaluate the clinical results. All data were statistically analyzed with SPSS 20.0 software.Results All the patients were followed up for 10 to 13 months( mean, 11.8 months). All of the calcaneus achieved anatomic reduction or nearly anatomic reduction. There were no incision infection, necrosis or hematoma. All fractures healed and fracture healing time ranged from 3 to 6 months( mean, 4.4 months). B?hler angle and Gissane angle were significantly improved in all patients( <0.01). According to Maryland foot score system, 13 cases were defined as excellent, 10 cases as good, and 2 cases as poor. The excellent and good rate was 91.3%.Two cases suffered from sural nerve injury. Conclusion Sinus tarsi approach and plate fixation with minimal-invasive percutaneous pedicle screw technology is an effective method for the treatment of calcaneal fractures of Sanders type II&III. It has the advantages of small trauma, safe operation, limited complicatio, table fixation.
Objective To investigate the clinical effects of the sinus tarsi approach and plate fixation with minimal-invasive percutaneous pedicle screw technology in treating calcaneal fractures of Sanders type II&III. Methods From May 2016 to December 2017, 23 patients with calcaneal fractures(Sanders type II&III) were treated with minimal-invasive percutaneous pedicle screw using the sinus tarsi approach and plate fixation. There were 15 males and 8 females with age ranging from 22 to 61 years(mean, 44.2 years). According to the classification of Sanders, 15 case were classified as type II, and eight as type III.The soft tissue condition after operation was recorded. Fracture reduction and healing time were measured. Record and compare the B?hler angle and Gissane angle before and after operation. Maryland foot score system was used to evaluate the clinical results. All data were statistically analyzed with SPSS 20.0 software.Results All the patients were followed up for 10 to 13 months( mean, 11.8 months). All of the calcaneus achieved anatomic reduction or nearly anatomic reduction. There were no incision infection, necrosis or hematoma. All fractures healed and fracture healing time ranged from 3 to 6 months( mean, 4.4 months). B?hler angle and Gissane angle were significantly improved in all patients( <0.01). According to Maryland foot score system, 13 cases were defined as excellent, 10 cases as good, and 2 cases as poor. The excellent and good rate was 91.3%.Two cases suffered from sural nerve injury. Conclusion Sinus tarsi approach and plate fixation with minimal-invasive percutaneous pedicle screw technology is an effective method for the treatment of calcaneal fractures of Sanders type II&III. It has the advantages of small trauma, safe operation, limited complicatio, table fixation.
引文
[1] Yao H, Liang T, Xu Y, et al. Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base[J]. Journal of Orthopaedic Surgery&Research, 2017, 12(1):43.
[2]孙伟,黄国伟,韦山,等.经跗骨窦切口空心螺钉内固定治疗舌型跟骨骨折[J].中华骨与关节外科杂志, 2015, 8(1):81-83.
[3]曾会斌,林炳禄.微创跗骨窦入路内固定术在跟骨骨折中的临床应用[J].微创医学, 2015, 10(5):670-671.
[4]彭雄,邱波.跟骨外侧U形切口结合解剖钢板内固定治疗SandersⅢ、Ⅳ型跟骨骨折疗效探讨[J].生物骨科材料与临床研究,2016, 13(4):25-27.
[5] Feng Y, Shui X, Wang J, et al. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures:a prospective randomized controlled trial[J]. BMC Musculoskeletal Disorders,2016, 17(1):288.
[6]邓纯博,刘学勇,阿良,等.跗骨窦入路与外侧入路治疗成人跟骨关节内移位骨折的meta分析[J].中国医科大学学报, 2016,45(9):818-823.
[7]徐浩,蒋元斌,刘耀辉,等.传统外侧"L"形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药, 2015(1):86-88.
[8] Qiang M, Chen Y, Jia X, et al. Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures:a three dimensional CT quantitative evaluation[J]. International Orthopaedics, 2017, 41(9):1945-1951.
[9]林烨澎,何志明,汪志中,等.跗骨窦小切口与传统外侧L型切口内固定治疗跟骨骨折的对比研究[J].中国骨科临床与基础研究杂志, 2016, 8(3):152-157.
[10]谭兴春,程亮.经跗骨窦切开内固定与外侧L形切口内固定治疗SandersⅢ型跟骨骨折[J].贵州医科大学学报, 2017, 42(1):113-117.
[2]孙伟,黄国伟,韦山,等.经跗骨窦切口空心螺钉内固定治疗舌型跟骨骨折[J].中华骨与关节外科杂志, 2015, 8(1):81-83.
[3]曾会斌,林炳禄.微创跗骨窦入路内固定术在跟骨骨折中的临床应用[J].微创医学, 2015, 10(5):670-671.
[4]彭雄,邱波.跟骨外侧U形切口结合解剖钢板内固定治疗SandersⅢ、Ⅳ型跟骨骨折疗效探讨[J].生物骨科材料与临床研究,2016, 13(4):25-27.
[5] Feng Y, Shui X, Wang J, et al. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures:a prospective randomized controlled trial[J]. BMC Musculoskeletal Disorders,2016, 17(1):288.
[6]邓纯博,刘学勇,阿良,等.跗骨窦入路与外侧入路治疗成人跟骨关节内移位骨折的meta分析[J].中国医科大学学报, 2016,45(9):818-823.
[7]徐浩,蒋元斌,刘耀辉,等.传统外侧"L"形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药, 2015(1):86-88.
[8] Qiang M, Chen Y, Jia X, et al. Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures:a three dimensional CT quantitative evaluation[J]. International Orthopaedics, 2017, 41(9):1945-1951.
[9]林烨澎,何志明,汪志中,等.跗骨窦小切口与传统外侧L型切口内固定治疗跟骨骨折的对比研究[J].中国骨科临床与基础研究杂志, 2016, 8(3):152-157.
[10]谭兴春,程亮.经跗骨窦切开内固定与外侧L形切口内固定治疗SandersⅢ型跟骨骨折[J].贵州医科大学学报, 2017, 42(1):113-117.