新型跟骨载距突螺钉导向器的解剖学设计及在跟骨关节内骨折中的应用
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摘要
目的探讨新型跟骨载距突螺钉导向器的解剖学设计及在跟骨关节内骨折中的准确性分析。方法 (1)采用20例成人新鲜及防腐足部标本为研究对象,对载距突进行解剖测量,设计生产载距突螺钉导向器;(2)回顾性分析2012年11月~2016年11月收治的60例(60足)跟骨关节内骨折患者临床资料:其中男37例,女13例,年龄19~67岁,平均41岁,将其分为A、B两组,各30例。两组患者均采用常规跟骨外侧"L"形切口,均采用载距突螺钉内固定;A组采用常规盲打;B组采用自制新型载距突螺钉导向器辅助下置入。比较两组患者的出血量、手术时间、术中透视次数、切口愈合时间及临床疗效,术后采用Maryland足评分进行疗效评价。结果 B组患者术中出血量(42.77±10.57)m L,手术时间为(38.56±11.45)min,术中透视次数(3.67±1.45)次,愈合时间(12.28±1.16)周,且总优良率为93.33%,均明显优于A组(P<0.05)。结论新型载距突螺钉导向器符合解剖学标准;采用新型跟骨载距突螺钉导向器辅助固定,明显提高载距突螺钉置入的准确性,减少术中出血量、减少手术时间,避免了因术中多次透视对骨科医生的放射性伤害,值得临床推广。
Objective To investigate the anatomical design of new-type calcaneus sustentaculum tali screw guide and the accuracy analysis in intra-articular calcaneal fractures. Methods(1)20 adult fresh and preserved foot specimens were used as the research object. The anatomical measurement of the sustentaculum tali was conducted, and the LGA screw guide was designed and produced.(2) The clinical data of 60 patients(60 feet) with intra-articular calcaneal fractures admitted from November 2012 to November 2016 retrospectively analyzed. Among them there were 37 males and 13 females, aged 19-67 years(average 41 years old). The patients were divided into group A and B, with 30 cases in each group. The two groups of patients were treated with conventional lateral calcaneal L-shaped incision, with internal fixation of sustentaculum tali screw. Group A received conventional blind implantation, while the screw of group B was implanted assisted by new self-made calcaneus sustentaculum tali screw guide. The bleeding volume, operation time, number of intraoperative fluoroscopy, incision healing time and clinical curative effect were compared between two groups. The Maryland foot score was used to evaluate the curative effect. Results The intraoperative bleeding(42.77±10.57) ml, operation time(38.56±11.45)min, number of intraoperative fluoroscopy(3.67±1.45)times and healing time(12.28±1.16)weeks, the total excellent and good rate 93.33% in group B were all significantly better than those in group A(P<0.05). Conclusion The new-type sustentaculum tali screw guide meets the anatomic standards. The application of new-type sustentaculum tali screw guide in assisting fixation significantly improves the accuracy of sustentaculum tali screw placement, reduces the intraoperative blood loss and the operation time, and avoids radiological injury to orthopedic surgeons due to multiple intraoperative fluoroscopy, which is worth clinical promotion.
Objective To investigate the anatomical design of new-type calcaneus sustentaculum tali screw guide and the accuracy analysis in intra-articular calcaneal fractures. Methods(1)20 adult fresh and preserved foot specimens were used as the research object. The anatomical measurement of the sustentaculum tali was conducted, and the LGA screw guide was designed and produced.(2) The clinical data of 60 patients(60 feet) with intra-articular calcaneal fractures admitted from November 2012 to November 2016 retrospectively analyzed. Among them there were 37 males and 13 females, aged 19-67 years(average 41 years old). The patients were divided into group A and B, with 30 cases in each group. The two groups of patients were treated with conventional lateral calcaneal L-shaped incision, with internal fixation of sustentaculum tali screw. Group A received conventional blind implantation, while the screw of group B was implanted assisted by new self-made calcaneus sustentaculum tali screw guide. The bleeding volume, operation time, number of intraoperative fluoroscopy, incision healing time and clinical curative effect were compared between two groups. The Maryland foot score was used to evaluate the curative effect. Results The intraoperative bleeding(42.77±10.57) ml, operation time(38.56±11.45)min, number of intraoperative fluoroscopy(3.67±1.45)times and healing time(12.28±1.16)weeks, the total excellent and good rate 93.33% in group B were all significantly better than those in group A(P<0.05). Conclusion The new-type sustentaculum tali screw guide meets the anatomic standards. The application of new-type sustentaculum tali screw guide in assisting fixation significantly improves the accuracy of sustentaculum tali screw placement, reduces the intraoperative blood loss and the operation time, and avoids radiological injury to orthopedic surgeons due to multiple intraoperative fluoroscopy, which is worth clinical promotion.
引文
[1]Phisitkul P,Sullivan JP,Goetz JE,et a1.Mximizing safety in screw placement for posterior facet fixation in calcaneus fractures:a cadav-eric radio-anatomical study[J].Foot Ankle Int,2013,34(9):1279-1285.
[2]Rammelt S,Zwipp H.Fractures of the calcaneus:Current treatment strategies[J].Acta Chir Orthop Traumatol Cech,2014,81(3):177-196.
[3]Yu GR,Pang QJ,Yu X,et a1.Surgical management for avulsion fracture of the calcaneal tuberosity[J].Orthop Surg,2013,5(3):196-202.
[4]Della Rocca GJ,Nork SE,Barei DP,et al.Fractures of the sustentaculum tali:Injury characteristics and surgical technique for reduction[J].Foot Ankle Int,2009,30(11)1037-1041.
[5]韦财.跟骨关节内骨折切开复位内固定是否植骨的临床疗效对比研究[J].中国医学创新,2016,13(7):110-113.
[6]Swanson SA,Clare MP,Sanders RW.Management of intraarticular fractures of the calcaneus[J].Foot Ankle Clin,2008,13(4):659-678.
[7]Pang QJ,Yu X,Guo ZH,et al.The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture:A finite element analysis[J].Pak J Med Sci,2014,30(5):1099-1103.
[8]Mitchell MJ,Mc Kinley JC,Robinson CM.The epidemiology of calcaneal fractures[J].Foot(Edinburgh Scotland),2009,19(4):197-200.
[9]Basile A.Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients[J].Foot Ankle Surg,2010,49(1):25-32.
[10]王冰,李涛,朱裕成,等.跟骨前部与载距突关系的解剖学研究及其临床意义[J].中国临床解剖学杂志,2012,30(2):131-135.
[11]王志杰,邹云雯,钟世镇,等.载距突的解剖学研究及其在跟骨关节内移位骨折手术中的应用[J].中华创伤骨科杂志,2009,11(2):129-132.
[12]李文壮,蔡湘波,陈峰,等.跟骨钢板治疗跟骨关节内骨折的疗效与解剖角度的关系[J].中华生物医学工程杂志,2008,14(3):228-231.
[13]俞光荣,燕晓宇.跟骨骨折治疗方法的选择[J].中华骨科杂志,2006,26(2):135-136.
[14]Jiang N,Lin QR,Diao XC,et al.Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:A meta-analysis of current evidence base[J].Int Orthop,2012,36(8):1615-1622.
[15]王林,校佰平.跟骨骨折的临床解剖学观察[J].现代实用医学,2011,23(9):1061-1063.
[16]Della Rocca GJ,Nork SE,Barei DP,et al.Fractures of the sustentaculum tali:Injury characteristics and surgical technique for reduction[J].Foot Ankle In,2009,30(11):1037-1041.
[17]张鹏,黄勇,张增方,等.跟骨载距突与其外侧壁关系的测量[J].青岛大学医学院学报,2007,43(6):507-509.
[18]王冰,杨春,王德广,等.跟骨前部的解剖测量与多层螺旋CT测量的比较研究及其临床意义[J].中国矫形外科杂志,2012,20(20):1868-1873.
[19]张翅,袁仕国,周孟君,等.点对点定位器辅助置入固定跟骨骨折载距突螺钉的初步报告[J].中华创伤骨科杂志,2010,12(11):1095-1099.
[20]刘丙根,庞清江,余霄,等.跟骨载距突螺钉导向器基础与临床上的准确性评价[J].中国临床解剖学杂志,2015,33(5):523-526.
[2]Rammelt S,Zwipp H.Fractures of the calcaneus:Current treatment strategies[J].Acta Chir Orthop Traumatol Cech,2014,81(3):177-196.
[3]Yu GR,Pang QJ,Yu X,et a1.Surgical management for avulsion fracture of the calcaneal tuberosity[J].Orthop Surg,2013,5(3):196-202.
[4]Della Rocca GJ,Nork SE,Barei DP,et al.Fractures of the sustentaculum tali:Injury characteristics and surgical technique for reduction[J].Foot Ankle Int,2009,30(11)1037-1041.
[5]韦财.跟骨关节内骨折切开复位内固定是否植骨的临床疗效对比研究[J].中国医学创新,2016,13(7):110-113.
[6]Swanson SA,Clare MP,Sanders RW.Management of intraarticular fractures of the calcaneus[J].Foot Ankle Clin,2008,13(4):659-678.
[7]Pang QJ,Yu X,Guo ZH,et al.The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture:A finite element analysis[J].Pak J Med Sci,2014,30(5):1099-1103.
[8]Mitchell MJ,Mc Kinley JC,Robinson CM.The epidemiology of calcaneal fractures[J].Foot(Edinburgh Scotland),2009,19(4):197-200.
[9]Basile A.Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients[J].Foot Ankle Surg,2010,49(1):25-32.
[10]王冰,李涛,朱裕成,等.跟骨前部与载距突关系的解剖学研究及其临床意义[J].中国临床解剖学杂志,2012,30(2):131-135.
[11]王志杰,邹云雯,钟世镇,等.载距突的解剖学研究及其在跟骨关节内移位骨折手术中的应用[J].中华创伤骨科杂志,2009,11(2):129-132.
[12]李文壮,蔡湘波,陈峰,等.跟骨钢板治疗跟骨关节内骨折的疗效与解剖角度的关系[J].中华生物医学工程杂志,2008,14(3):228-231.
[13]俞光荣,燕晓宇.跟骨骨折治疗方法的选择[J].中华骨科杂志,2006,26(2):135-136.
[14]Jiang N,Lin QR,Diao XC,et al.Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:A meta-analysis of current evidence base[J].Int Orthop,2012,36(8):1615-1622.
[15]王林,校佰平.跟骨骨折的临床解剖学观察[J].现代实用医学,2011,23(9):1061-1063.
[16]Della Rocca GJ,Nork SE,Barei DP,et al.Fractures of the sustentaculum tali:Injury characteristics and surgical technique for reduction[J].Foot Ankle In,2009,30(11):1037-1041.
[17]张鹏,黄勇,张增方,等.跟骨载距突与其外侧壁关系的测量[J].青岛大学医学院学报,2007,43(6):507-509.
[18]王冰,杨春,王德广,等.跟骨前部的解剖测量与多层螺旋CT测量的比较研究及其临床意义[J].中国矫形外科杂志,2012,20(20):1868-1873.
[19]张翅,袁仕国,周孟君,等.点对点定位器辅助置入固定跟骨骨折载距突螺钉的初步报告[J].中华创伤骨科杂志,2010,12(11):1095-1099.
[20]刘丙根,庞清江,余霄,等.跟骨载距突螺钉导向器基础与临床上的准确性评价[J].中国临床解剖学杂志,2015,33(5):523-526.