外踝下小切口撬拨复位克氏针内固定治疗跟骨关节内压缩性骨折
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摘要
目的探讨小切口下撬拨复位、克氏针内固定治疗跟骨关节内压缩性骨折的临床效果。方法 2012年6月～2016年10月采用外踝下小切口撬拨复位、克氏针内固定治疗15例跟骨关节内压缩性骨折患者,术前CT示关节面塌陷均>2 mm,根据Sanders分型Ⅰ型3例,Ⅱ型10例,Ⅲ型2例;观察切口长度、手术时间等一般情况,X线测量Bohler角和Gissane角,三维CT了解关节面复位及再次塌陷情况。踝关节功能根据Maryland足部功能评分标准进行评价。结果手术切口3～5 cm,平均3.8 cm;手术时间32～56 min,平均42 min;术中出血量10～30 mL,平均18 mL。术后切口均Ⅰ期愈合。术后即刻Bohler角、Gissane角分别为(34.1±4.1)°、(128.4±2.9)°,术后1年分别为(33.9±4.2)°、(128.3±2.7)°,两时间点比较差异均无统计学意义。术后即刻关节面解剖复位率为93.3%。末次随访时踝关节功能优良率为92.9%。结论外踝下小切口撬拨复位、克氏针内固定治疗跟骨关节内压缩性骨折能充分显露关节面,具有手术损伤小、操作简便、经济实用、并发症少,踝关节功能恢复满意等优点。
Objective To explore the clinical effect of minimal incision, poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus.Methods From June 2012 to October 2016, 15 patients with compressive intra-articular fractures of calcaneus were included. All 15 patients with articular surface collapse>2 mm underwent minimal incision poking reduction and Kirschner wire internal fixation. The incision length, surgical duration, incision healing,fracture healing, loss of articular surface reduction, and ankle joint function were used for evaluation. The Bohler angle and the Gissane angle were measured in X-ray. The three-dimensional CT was used to measure the articular surface reduction and re-collapse. Ankle function was evaluated according to the Maryland Foot Function Rating criteria. Results The incision length was 3～5 cm, surgical duration was 32～56 min,intraoperative blood loss was 10～30 mL, and the incision healed smoothly. There was no significant difference in Bohler angle and Gissane angle immediately and 1 year after operation. The anatomic reduction ratio of articular surface was 93.3%. According to Maryland Foot Score system, 10 cases were rated as excellent, 3 as good, 1 as fair, and the rate of excellent and good outcomes was 92.9%. There were no significant differences in the Bohler angle and Gissane angle immediately after surgery and the last follow-up(P>0.05).Conclusion The minimal incision poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus can expose fully. It has the advantages of small injury, easy operation, less complications, and satisfactory ankle function.
Objective To explore the clinical effect of minimal incision, poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus.Methods From June 2012 to October 2016, 15 patients with compressive intra-articular fractures of calcaneus were included. All 15 patients with articular surface collapse>2 mm underwent minimal incision poking reduction and Kirschner wire internal fixation. The incision length, surgical duration, incision healing,fracture healing, loss of articular surface reduction, and ankle joint function were used for evaluation. The Bohler angle and the Gissane angle were measured in X-ray. The three-dimensional CT was used to measure the articular surface reduction and re-collapse. Ankle function was evaluated according to the Maryland Foot Function Rating criteria. Results The incision length was 3～5 cm, surgical duration was 32～56 min,intraoperative blood loss was 10～30 mL, and the incision healed smoothly. There was no significant difference in Bohler angle and Gissane angle immediately and 1 year after operation. The anatomic reduction ratio of articular surface was 93.3%. According to Maryland Foot Score system, 10 cases were rated as excellent, 3 as good, 1 as fair, and the rate of excellent and good outcomes was 92.9%. There were no significant differences in the Bohler angle and Gissane angle immediately after surgery and the last follow-up(P>0.05).Conclusion The minimal incision poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus can expose fully. It has the advantages of small injury, easy operation, less complications, and satisfactory ankle function.
引文
[1]温晓东,李玉茂,张玉九.SandersⅡ、Ⅲ型跟骨骨折术后切口并发症影响因素分析[J].中国骨与关节损伤杂志,2017,32(2):215-217.
[2]Zhang J,Ebraheim N,LauséGE.A comparison of absorbable screwsand metallic plates in treating calcaneal fractures:a prospective randomized trial[J].J Trauma Acute Care Surg,2012,72(2):E106-E110.
[3]Zwipp H,Rammelt S,Amlang M,et al.Operative treatment of displaced intra-articular calcaneal fractures[J].Oper Orthop Traumatol,2013,25(6):554-568.
[4]陈群超,郝跃峰.经皮微创治疗跟骨骨折的手术技巧与适应证[J].中国矫形外科杂志,2017,25(10):903-907.
[5]苗旭东.微创技术治疗跟骨骨折进展[J].中国骨伤,2018,31(7):591-593.
[6]沙良宽,田家祥,李敬祥,等.撬拨复位与切开复位内固定治疗SandersⅡ型跟骨骨折的比较[J].中国修复重建外科杂志,2015,29(5):558-562.
[7]周海超,任昊旸,李兵,等.内侧撑开技术联合跗骨窦入路治疗跟骨关节内骨折[J].中国修复重建外科杂志,2016,30(7):830-835.
[8]张宏伟,张敬堂,刘思杰.经跗骨窦入路手术治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究[J].中国骨与关节损伤杂志,2018,33(8):879-881.
[9]孔令超,宁仁德,谢武昆,等.微型钢板结合跗骨窦切口治疗SandersⅡ、Ⅲ型跟骨骨折的疗效[J].临床骨科杂志,2017,20(4):487-489.
[10]李云鹏,张路,赵文志.经跗骨窦切口入路治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J].大连医科大学学报,2018,40(1):33-38,46.
[11]Kapil Mani KC,Acharya P,Dirgha Raj RC,et al.A modified minimally invasive technique for intra-articular displaced calcaneal fractures fixed by transverse and axial screws[J].Eur J Orthop Surg Traumatol,2017,27(7):997-1004.
[12]周海超,杨云峰.微创技术治疗跟骨骨折的研究进展[J].同济大学学报(医学版),2017,38(1):124-127,132.
[13]郭建华,郭立平,马志刚.微创撬拨和切开复位内固定治疗Sanders II型跟骨骨折疗效分析[J].中国矫形外科杂志,2017,25(6):561-564.
[14]许灿,李明清,李康华,等.跟骨三维形态学参数与踝后足功能的关系[J].中国组织工程研究,2016,20(46):6899-6906.
[15]陈雁西,施忠民,金丹,等.跟骨骨折术后三维形态学特征与踝-后足功能的相关性:一项多中心研究结果[J].中华骨科杂志,2013,33(4):291-297.
[16]唐三元,朱学敏,杨辉,等.后距下关节面复位质量与跟骨骨折疗效的相关性研究[J].中国矫形外科杂志,2015,23(16):1448-1453.
[17]黄海晶,马信龙,马剑雄,等.正常与畸形愈合跟骨应力分布的比较研究[J].中华骨科杂志,2013,33(4):336-341.
[18]方志强.外踝下小切口结合微型锁定钢板治疗跟骨骨折体会[J].中国矫形外科杂志,2015,23(18):1722-1724.
[19]Backes M,Schep NW,Luitse JS,et al.Erratum to:the effect of postoperative wound infections on functional outcome following intraarticular calcaneal fractures[J].Arch Orthop Trauma Surg,2015,135(8):1053.
[20]董福,陆春,朱金荣,等.距下关节后侧入路关节镜辅助下微创治疗跟骨骨折[J].中国修复重建外科杂志,2017,31(1):36-41.
[21]张大保,毛波.跗骨窦入路治疗跟骨SandersⅡ、Ⅲ型骨折的体会[J].中国微创外科杂志,2017,17(3):242-244,248.
[22]马骏,何斌,姜曙祥,等.“八”字微创入路内固定治疗跟骨骨折疗效观察[J].局解手术学杂志,2017,26(4):256-259.
[2]Zhang J,Ebraheim N,LauséGE.A comparison of absorbable screwsand metallic plates in treating calcaneal fractures:a prospective randomized trial[J].J Trauma Acute Care Surg,2012,72(2):E106-E110.
[3]Zwipp H,Rammelt S,Amlang M,et al.Operative treatment of displaced intra-articular calcaneal fractures[J].Oper Orthop Traumatol,2013,25(6):554-568.
[4]陈群超,郝跃峰.经皮微创治疗跟骨骨折的手术技巧与适应证[J].中国矫形外科杂志,2017,25(10):903-907.
[5]苗旭东.微创技术治疗跟骨骨折进展[J].中国骨伤,2018,31(7):591-593.
[6]沙良宽,田家祥,李敬祥,等.撬拨复位与切开复位内固定治疗SandersⅡ型跟骨骨折的比较[J].中国修复重建外科杂志,2015,29(5):558-562.
[7]周海超,任昊旸,李兵,等.内侧撑开技术联合跗骨窦入路治疗跟骨关节内骨折[J].中国修复重建外科杂志,2016,30(7):830-835.
[8]张宏伟,张敬堂,刘思杰.经跗骨窦入路手术治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究[J].中国骨与关节损伤杂志,2018,33(8):879-881.
[9]孔令超,宁仁德,谢武昆,等.微型钢板结合跗骨窦切口治疗SandersⅡ、Ⅲ型跟骨骨折的疗效[J].临床骨科杂志,2017,20(4):487-489.
[10]李云鹏,张路,赵文志.经跗骨窦切口入路治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J].大连医科大学学报,2018,40(1):33-38,46.
[11]Kapil Mani KC,Acharya P,Dirgha Raj RC,et al.A modified minimally invasive technique for intra-articular displaced calcaneal fractures fixed by transverse and axial screws[J].Eur J Orthop Surg Traumatol,2017,27(7):997-1004.
[12]周海超,杨云峰.微创技术治疗跟骨骨折的研究进展[J].同济大学学报(医学版),2017,38(1):124-127,132.
[13]郭建华,郭立平,马志刚.微创撬拨和切开复位内固定治疗Sanders II型跟骨骨折疗效分析[J].中国矫形外科杂志,2017,25(6):561-564.
[14]许灿,李明清,李康华,等.跟骨三维形态学参数与踝后足功能的关系[J].中国组织工程研究,2016,20(46):6899-6906.
[15]陈雁西,施忠民,金丹,等.跟骨骨折术后三维形态学特征与踝-后足功能的相关性:一项多中心研究结果[J].中华骨科杂志,2013,33(4):291-297.
[16]唐三元,朱学敏,杨辉,等.后距下关节面复位质量与跟骨骨折疗效的相关性研究[J].中国矫形外科杂志,2015,23(16):1448-1453.
[17]黄海晶,马信龙,马剑雄,等.正常与畸形愈合跟骨应力分布的比较研究[J].中华骨科杂志,2013,33(4):336-341.
[18]方志强.外踝下小切口结合微型锁定钢板治疗跟骨骨折体会[J].中国矫形外科杂志,2015,23(18):1722-1724.
[19]Backes M,Schep NW,Luitse JS,et al.Erratum to:the effect of postoperative wound infections on functional outcome following intraarticular calcaneal fractures[J].Arch Orthop Trauma Surg,2015,135(8):1053.
[20]董福,陆春,朱金荣,等.距下关节后侧入路关节镜辅助下微创治疗跟骨骨折[J].中国修复重建外科杂志,2017,31(1):36-41.
[21]张大保,毛波.跗骨窦入路治疗跟骨SandersⅡ、Ⅲ型骨折的体会[J].中国微创外科杂志,2017,17(3):242-244,248.
[22]马骏,何斌,姜曙祥,等.“八”字微创入路内固定治疗跟骨骨折疗效观察[J].局解手术学杂志,2017,26(4):256-259.