跟骨骨折的微创手术治疗进展
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摘要
跟骨骨折是最常见的跗骨骨折,多由高处跌落或挤压所致。跟骨骨折的分型方法有多种,目前临床常用的分型方式为Essex-Lopresti分型和Sanders分型。跟骨解剖结构复杂,局部软组织覆盖差,治疗比较困难且容易出现并发症,现阶段跟骨骨折的治疗仍具有一定的挑战性。传统的手术治疗方法效果较差,并发症较多。随着技术的发展,微创手术疗法已成为外科手术的发展方向。微创手术治疗跟骨骨折,既能使关节很好的复位,又可以减少并发症的发生。本文就跟骨骨折的分型和微创治疗进展进行综述,以期为临床跟骨骨折微创手术的选择提供一定的参考。
Calcaneal fractures are the most common tarsal fractures,most of which are caused by falls from high altitudes or compression. There are many classification methods for calcaneal fractures. Currently,the commonly used clinical classification methods are EssexLopresti classification and Sanders classification. Calcaneal anatomic structure is complex,local soft tissue coverage is poor,treatment is difficult and prone to many complications. At present,the treatment of calcaneal fracture is still challenging. The effect of traditional surgical treatment is poor with many complications. Minimally invasive surgery for calcaneal fracture has become the future of surgery with the development of technology. It can not only make the joint very good reduction,but also reduce the occurrence of complications. This article reviews the classification of calcaneal fractures and the progress of minimally invasive treatment of calcaneal fractures,in order to provide a reference for the choice of minimally invasive surgery of calcaneal fracture.
Calcaneal fractures are the most common tarsal fractures,most of which are caused by falls from high altitudes or compression. There are many classification methods for calcaneal fractures. Currently,the commonly used clinical classification methods are EssexLopresti classification and Sanders classification. Calcaneal anatomic structure is complex,local soft tissue coverage is poor,treatment is difficult and prone to many complications. At present,the treatment of calcaneal fracture is still challenging. The effect of traditional surgical treatment is poor with many complications. Minimally invasive surgery for calcaneal fracture has become the future of surgery with the development of technology. It can not only make the joint very good reduction,but also reduce the occurrence of complications. This article reviews the classification of calcaneal fractures and the progress of minimally invasive treatment of calcaneal fractures,in order to provide a reference for the choice of minimally invasive surgery of calcaneal fracture.
引文
[1]Ebraheim NA,Elgafy H,Sabry FF,et al. Calcaneus fractures with subluxation of the posterior facet. A surgical indication[J]. Clin Orthop Relat Res, 2000,377:210-216. doi:10. 1097/00003086-200008000-00028.
[2]刘立峰,蔡锦方.跟骨骨折的分型与治疗[J].中国骨伤,2004,17(8):66-68. doi:10. 3969/j. issn. 1003-0034. yyyy. nn. zzz.
[3]Crosby LA,Fitzgibbons T. Computerized tomography scanning of acute intra-articular fractures of the calcaneus:a new classification system[J].J Bone Joint Surg(Am),1990,72(6):852-859. doi:10. 2106/00004623-199072060-00009.
[4]刘尧,方龙云.跟骨骨折的分型及治疗进展[J].甘肃医药,2018,37(3):215-217. doi:10. 15975/j. cnki. gsyy. 2018. 03. 008.
[5]王宝军,马立峰.跟骨骨折分型和治疗的研究进展[J].国际外科学杂志,2014,41(11):721-724. doi:10. 3760/cma. j. issn. 1673-4203. 2014. 11. 001.
[6]张晓东.闭合撬拨复位和切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床效果比照观察[J].中国医药指南,2016,14(25):137-138. doi:10. 15912/j. cnki. gocm. 2016. 25. 112.
[7]曾凡辉,涂淑强,帅永明,等.经皮撬拨复位空心钉与跗骨窦切口钢板内固定治疗跟骨骨折的比较[J].中国骨与关节损伤杂志,2018,33(6):653-655. doi:10. 7531/j. issn. 1672-9935. 2018. 06. 039.
[8]刘亮,周恩瑜,陈宇.经皮撬拨复位空心螺钉内固定SandersⅡ、Ⅲ型跟骨骨折[J].局解手术学杂志,2018,27(8):581-585. doi:10. 11659/jjssx. 01E018051.
[9]伍凯,林健,黄建华,等.扩大L型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析[J].上海交通大学学报(医学版),2014,34(7):1043-1048. doi:10. 3969/j. issn. 1674-8115. 2014. 07.017.
[10]于涛,杨云峰,俞光荣.微创技术在治疗跟骨骨折中的应用进展[J].中国修复重建外科杂志,2013,27(2):236-239. doi:10.7507/1002-1892. 20130051.
[11] Geel CW,Flemister AS Jr. Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft[J]. J Trauma,2001,50(6):1083-1089. doi:10. 1097/00005373-200106000-00017.
[12]Rammelt S,Zwipp H. Calcaneus fractures:facts,controversies and recent developments[J]. Injury,Int. J. Care Injured,2004,35:443-461. doi:10. 1016/j. injury. 2003. 10. 006.
[13]田智广,潘进社.跟骨骨折手术入路进展[J].中国矫形外科杂志,2012,20(14):1302-1305. doi:10. 3977/j. issn. 1005-8478.2012. 14. 15.
[14]朱军,肖玉周,陈笑天,等.微创技术治疗跟骨骨折的进展[J].包头医学院学报,2018,34(6):127-129. doi:10. 16833/j. cnki.jbmc. 2018. 06. 053.
[15]李来峰,王辉,赵仪云,等.跗骨窦切口联合经皮置钉技术微创治疗SandersⅢ型跟骨骨折[J].中国矫形外科杂志,2015,23(20):1850-1853. doi:10. 3977/j. issn. 1005-8478. 2015. 20. 06.
[16]李伟,张克民,陈雪梅,等.微创小切口钛板内固定治疗跟骨骨折[J].中华损伤与修复杂志(电子版),2012,7(5):506-511. doi:10. 3877/cma. j. issn. 1673-9450. 2012. 05. 009.
[17]孙昌俊,毕若杰,李军,等.八字微创切口结合改良Donati-Allgower缝合法治疗糖尿病患者跟骨骨折的疗效分析[J].中国煤炭工业医学杂志,2017,20(10):1161-1165. doi:10. 11723/mtgyyx1007-9564 201710011.
[18]赵志明,董桂贤,于桂泳,等.撬拨复位结合Ilizarov技术治疗胫骨平台SchatzkerⅣ-Ⅵ型骨折[J].临床骨科杂志,2016,19(2):211-213. doi:10. 3969/j. issn. 1008-0287. 2016. 02. 032.
[19]梅晓龙,曾宪铁,舒衡生. Ilizarov技术与切开复位内固定治疗跟骨骨折的疗效比较[J].中华骨科杂志,2016,36(9):528-533. doi:10. 3760/cma. j. issn. 0253-2352. 2016. 09. 003.
[20]王鑫,何斌,黄擘,等.解剖锁定钛板、空心钉、外固定架固定治疗跟骨骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(12):1266-1269. doi:10. 7531/j. issn. 1672-9935. 2017. 12.011.
[21]Takahashi M,Noda M,Saegusa Y. A new treatment for avulsion fracture of the calcaneus using an Ilizarov external fixator[J]. Injury,2013,44(11):1640-1643. doi:10. 1016/j. injury. 2013. 04. 019.
[22]温必成,李海江,邹豪杰,等.撑开式复位外固定架微创治疗跟骨骨折的临床应用[J].中国矫形外科杂志,2012,20(6):574-576.doi:10. 3977/j. issn. 1005-8478. 2012. 06. 30.
[23]施忠民.跟骨关节内骨折的微创治疗[J].华南国防医学杂志,2015,29(3):163-165. doi:10. 3969/j. issn. 1009-2595. 2015.03. 001.
[24]臧宏伟,汪琦,杨坤,等.环形外固定架辅助治疗跟骨骨折合并糖尿病的临床应用[J].山西医药杂志,2018,47(10):1175-1176.doi:10. 3969/j. issn. 0253-9926. 2018. 10. 027.
[25]舒文,王栋栋,陈凯,等.经皮球囊扩张复位结合硫酸钙植骨治疗跟骨骨折的研究[J].生物骨科材料与临床研究,2016,13(1):46-48. doi:10. 3969/j. issn. 1672-5972. 2016. 01. 015.
[26]Labbe JL,Peres O,Leclair O,et al. Minimally invasivetreatment of displaced intra-articular calcaneal fractures using the balloon kyphoplasty technique:preliminary study[J]. Orthop Traumatol Surg Res,2013,99(7):829-836. doi:10. 1016/j. otsr. 2013. 06. 008.
[27]荆吉峰.距下关节融合术与切开复位内固定治疗SandersⅢ型跟骨骨折的疗效与安全性对比[J].中国伤残医学,2017,25(24):41-42. doi:10. 13214/j. cnki. cjotadm. 2017. 24. 025.
[28]许福生,刘方刚,陈步俊,等.比较三种方法治疗跟骨SandersⅣ型骨折[J].中国矫形外科杂志,2011,19(20):1757-1759. doi:10. 3977/j. issn. 1005-8478. 2011. 20. 28.
[29]石国栋,李波,杨兴华,等.改良外侧入路距下关节植骨融合治疗严重跟骨骨折畸形愈合[J].实用骨科杂志,2016,22(2):126-129. doi:10. 13795/j. cnki. sgkz. 2016. 02. 009.
[30]Hutchinson ID,Baxter JR,Gilbert S,et al. How do hindfoot fusions affect ankle biomechanics:a cadaver model[J]. Clin Orthop Relat Res,2016,474(4):1008-1016. doi:10. 1007/s11999-015-4671-5.
[31]余双喜,王娜,李思云.关节镜辅助下切开复位内固定治疗跟骨骨折的临床疗效[J].实用中西医结合临床,2018,18(2):124-127. doi:10. 13638/j. issn. 1671-4040. 2018. 02. 071.
[32]吴勐,滕云升,郭永明,等.关节镜辅助下经跗骨窦切口内固定治疗跟骨关节内骨折[J].中国骨与关节损伤杂志,2015,30(10):1076-1078. doi:10. 7531/j. issn. 1672-9935. 2015. 10. 021.
[33]刘凯,王红川,蒋俊威,等. 3D打印辅助小切口复位内固定治疗跟骨骨折[J].华西医学,2016,31(5):859-862. doi:10. 7507/1002-0179. 201600234.
[34]沈美华,施凯兵,张红,等. 3D打印技术在SandersⅢ、Ⅳ型跟骨骨折手术中的应用[J].中国矫形外科杂志,2018,26(14):1259-1263. doi:10. 3977/j. issn. 1005-8478. 2018. 14. 03.
[35] Falis M,Pyszel K. Treatment of displaced intra-articular calcaneal fractures by intramedullary nail. Preliminary Report[J]. Ortop Traumatol Rehabil,2016,18(2):141-147. doi:10. 5604/15093492.1205021.
[36] Fascione F,Di Mauro M,Guelfi M,et al. Surgical treatment of displaced intraarticular calcaneal fractures by a minimally invasive technique using a locking nail:a preliminary study[J]. Foot Ankle Surg,2018. doi:10. 1016/j. fas. 2018. 08. 004.
[37] Potter MQ,Nunley JA. Long term functional outcomes after operative treatment for intra-articular fractures of the calcaneus[J]. J Bone Joint Surg AM,2009,91(8):1854-1860. doi:10. 2106/JBJS. H. 01475.
[2]刘立峰,蔡锦方.跟骨骨折的分型与治疗[J].中国骨伤,2004,17(8):66-68. doi:10. 3969/j. issn. 1003-0034. yyyy. nn. zzz.
[3]Crosby LA,Fitzgibbons T. Computerized tomography scanning of acute intra-articular fractures of the calcaneus:a new classification system[J].J Bone Joint Surg(Am),1990,72(6):852-859. doi:10. 2106/00004623-199072060-00009.
[4]刘尧,方龙云.跟骨骨折的分型及治疗进展[J].甘肃医药,2018,37(3):215-217. doi:10. 15975/j. cnki. gsyy. 2018. 03. 008.
[5]王宝军,马立峰.跟骨骨折分型和治疗的研究进展[J].国际外科学杂志,2014,41(11):721-724. doi:10. 3760/cma. j. issn. 1673-4203. 2014. 11. 001.
[6]张晓东.闭合撬拨复位和切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床效果比照观察[J].中国医药指南,2016,14(25):137-138. doi:10. 15912/j. cnki. gocm. 2016. 25. 112.
[7]曾凡辉,涂淑强,帅永明,等.经皮撬拨复位空心钉与跗骨窦切口钢板内固定治疗跟骨骨折的比较[J].中国骨与关节损伤杂志,2018,33(6):653-655. doi:10. 7531/j. issn. 1672-9935. 2018. 06. 039.
[8]刘亮,周恩瑜,陈宇.经皮撬拨复位空心螺钉内固定SandersⅡ、Ⅲ型跟骨骨折[J].局解手术学杂志,2018,27(8):581-585. doi:10. 11659/jjssx. 01E018051.
[9]伍凯,林健,黄建华,等.扩大L型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析[J].上海交通大学学报(医学版),2014,34(7):1043-1048. doi:10. 3969/j. issn. 1674-8115. 2014. 07.017.
[10]于涛,杨云峰,俞光荣.微创技术在治疗跟骨骨折中的应用进展[J].中国修复重建外科杂志,2013,27(2):236-239. doi:10.7507/1002-1892. 20130051.
[11] Geel CW,Flemister AS Jr. Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft[J]. J Trauma,2001,50(6):1083-1089. doi:10. 1097/00005373-200106000-00017.
[12]Rammelt S,Zwipp H. Calcaneus fractures:facts,controversies and recent developments[J]. Injury,Int. J. Care Injured,2004,35:443-461. doi:10. 1016/j. injury. 2003. 10. 006.
[13]田智广,潘进社.跟骨骨折手术入路进展[J].中国矫形外科杂志,2012,20(14):1302-1305. doi:10. 3977/j. issn. 1005-8478.2012. 14. 15.
[14]朱军,肖玉周,陈笑天,等.微创技术治疗跟骨骨折的进展[J].包头医学院学报,2018,34(6):127-129. doi:10. 16833/j. cnki.jbmc. 2018. 06. 053.
[15]李来峰,王辉,赵仪云,等.跗骨窦切口联合经皮置钉技术微创治疗SandersⅢ型跟骨骨折[J].中国矫形外科杂志,2015,23(20):1850-1853. doi:10. 3977/j. issn. 1005-8478. 2015. 20. 06.
[16]李伟,张克民,陈雪梅,等.微创小切口钛板内固定治疗跟骨骨折[J].中华损伤与修复杂志(电子版),2012,7(5):506-511. doi:10. 3877/cma. j. issn. 1673-9450. 2012. 05. 009.
[17]孙昌俊,毕若杰,李军,等.八字微创切口结合改良Donati-Allgower缝合法治疗糖尿病患者跟骨骨折的疗效分析[J].中国煤炭工业医学杂志,2017,20(10):1161-1165. doi:10. 11723/mtgyyx1007-9564 201710011.
[18]赵志明,董桂贤,于桂泳,等.撬拨复位结合Ilizarov技术治疗胫骨平台SchatzkerⅣ-Ⅵ型骨折[J].临床骨科杂志,2016,19(2):211-213. doi:10. 3969/j. issn. 1008-0287. 2016. 02. 032.
[19]梅晓龙,曾宪铁,舒衡生. Ilizarov技术与切开复位内固定治疗跟骨骨折的疗效比较[J].中华骨科杂志,2016,36(9):528-533. doi:10. 3760/cma. j. issn. 0253-2352. 2016. 09. 003.
[20]王鑫,何斌,黄擘,等.解剖锁定钛板、空心钉、外固定架固定治疗跟骨骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(12):1266-1269. doi:10. 7531/j. issn. 1672-9935. 2017. 12.011.
[21]Takahashi M,Noda M,Saegusa Y. A new treatment for avulsion fracture of the calcaneus using an Ilizarov external fixator[J]. Injury,2013,44(11):1640-1643. doi:10. 1016/j. injury. 2013. 04. 019.
[22]温必成,李海江,邹豪杰,等.撑开式复位外固定架微创治疗跟骨骨折的临床应用[J].中国矫形外科杂志,2012,20(6):574-576.doi:10. 3977/j. issn. 1005-8478. 2012. 06. 30.
[23]施忠民.跟骨关节内骨折的微创治疗[J].华南国防医学杂志,2015,29(3):163-165. doi:10. 3969/j. issn. 1009-2595. 2015.03. 001.
[24]臧宏伟,汪琦,杨坤,等.环形外固定架辅助治疗跟骨骨折合并糖尿病的临床应用[J].山西医药杂志,2018,47(10):1175-1176.doi:10. 3969/j. issn. 0253-9926. 2018. 10. 027.
[25]舒文,王栋栋,陈凯,等.经皮球囊扩张复位结合硫酸钙植骨治疗跟骨骨折的研究[J].生物骨科材料与临床研究,2016,13(1):46-48. doi:10. 3969/j. issn. 1672-5972. 2016. 01. 015.
[26]Labbe JL,Peres O,Leclair O,et al. Minimally invasivetreatment of displaced intra-articular calcaneal fractures using the balloon kyphoplasty technique:preliminary study[J]. Orthop Traumatol Surg Res,2013,99(7):829-836. doi:10. 1016/j. otsr. 2013. 06. 008.
[27]荆吉峰.距下关节融合术与切开复位内固定治疗SandersⅢ型跟骨骨折的疗效与安全性对比[J].中国伤残医学,2017,25(24):41-42. doi:10. 13214/j. cnki. cjotadm. 2017. 24. 025.
[28]许福生,刘方刚,陈步俊,等.比较三种方法治疗跟骨SandersⅣ型骨折[J].中国矫形外科杂志,2011,19(20):1757-1759. doi:10. 3977/j. issn. 1005-8478. 2011. 20. 28.
[29]石国栋,李波,杨兴华,等.改良外侧入路距下关节植骨融合治疗严重跟骨骨折畸形愈合[J].实用骨科杂志,2016,22(2):126-129. doi:10. 13795/j. cnki. sgkz. 2016. 02. 009.
[30]Hutchinson ID,Baxter JR,Gilbert S,et al. How do hindfoot fusions affect ankle biomechanics:a cadaver model[J]. Clin Orthop Relat Res,2016,474(4):1008-1016. doi:10. 1007/s11999-015-4671-5.
[31]余双喜,王娜,李思云.关节镜辅助下切开复位内固定治疗跟骨骨折的临床疗效[J].实用中西医结合临床,2018,18(2):124-127. doi:10. 13638/j. issn. 1671-4040. 2018. 02. 071.
[32]吴勐,滕云升,郭永明,等.关节镜辅助下经跗骨窦切口内固定治疗跟骨关节内骨折[J].中国骨与关节损伤杂志,2015,30(10):1076-1078. doi:10. 7531/j. issn. 1672-9935. 2015. 10. 021.
[33]刘凯,王红川,蒋俊威,等. 3D打印辅助小切口复位内固定治疗跟骨骨折[J].华西医学,2016,31(5):859-862. doi:10. 7507/1002-0179. 201600234.
[34]沈美华,施凯兵,张红,等. 3D打印技术在SandersⅢ、Ⅳ型跟骨骨折手术中的应用[J].中国矫形外科杂志,2018,26(14):1259-1263. doi:10. 3977/j. issn. 1005-8478. 2018. 14. 03.
[35] Falis M,Pyszel K. Treatment of displaced intra-articular calcaneal fractures by intramedullary nail. Preliminary Report[J]. Ortop Traumatol Rehabil,2016,18(2):141-147. doi:10. 5604/15093492.1205021.
[36] Fascione F,Di Mauro M,Guelfi M,et al. Surgical treatment of displaced intraarticular calcaneal fractures by a minimally invasive technique using a locking nail:a preliminary study[J]. Foot Ankle Surg,2018. doi:10. 1016/j. fas. 2018. 08. 004.
[37] Potter MQ,Nunley JA. Long term functional outcomes after operative treatment for intra-articular fractures of the calcaneus[J]. J Bone Joint Surg AM,2009,91(8):1854-1860. doi:10. 2106/JBJS. H. 01475.