跗骨窦改良切口结合微型钢板及内侧柱螺钉治疗SandersⅢ型跟骨骨折
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摘要
目的探讨采用跗骨窦改良切口结合微型钢板及内侧柱螺钉治疗SandersⅢ型跟骨骨折的临床疗效。方法回顾性分析2016年1月至2016年12月采用跗骨窦改良切口利用微型钢板结合内侧柱螺钉治疗的31例SandersⅢ型跟骨骨折患者资料,其中男21例,女10例;年龄22～43岁,平均32.4岁;左侧18例,右侧13例。统计术后并发症并比较手术前后和末次随访时Bohler's角、Gissane's角、跟骨高度、宽度,采用AOFAS(美国矫形外科足踝协会)踝与后足评分系统对临床疗效进行评价。结果 31例患者均完成随访,时间21～23.8个月,平均22.5个月;3.9～6.3个月内骨折骨性愈合,平均5.1个月。末次随访时Bohler's、Gissane's角、跟骨高度、跟骨宽度与术前比较差异有统计学意义(P<0.01)。AOFAS评分由术前的(64.3±1.1)提高至术后的(85.7±3.2),其中优22例,良5例。术后未出现伤口感染、皮瓣坏死、腓骨肌腱激惹、内固定外露、腓肠神经损伤等常见并发症。结论采用跗骨窦改良切口治疗SandersⅢ型跟骨骨折具有操作便捷、关节面暴露充分的优势,利用微型钢板结合内侧柱螺钉固定骨折能防止后期跟骨内翻、减少并发症。
Objective To explore the minimally invasive treatment of Sanders Ⅲ calcaneal fractures with mini-plate and internal column screw. Methods The clinical data of 31 cases with Sanders type Ⅲ calcaneal fracture treated by modified tarsal sinus incision with mini-plate and medial column screw from January 2016 to December 2016 was retrospectively analyzed. Among them, there were 21 males and 10 females, aged 22～43 years, with an average age of 32.4 years. 18 were on the left and 13 on the right.Postoperative complications were counted and differences before and after operation of Bohler's angle,Gissane's angle, calcaneal height and width were compared. Finally,AOFAS(Ankle and hind foot scoring system)was used to evaluate the clinical efficacy. Results All the 31 patients were followed up from 21 to23.8 months, and the average follow-up time was 22.5 months. All patients achieved bone union, and the mean duration of fracture healing was 5.1 months. At the last follow-up, Bohler angle, Gissane angle, calcaneal height and calcaneal width were significantly different from those before operation(P<0.01). AOFAS score increased from(64.3±1.1) preoperatively to(85.7±3.2) postoperatively, of which 22 were excellent and 5 were good. There were no common complications such as wound infection, skin flap necrosis, peroneal tendon irritation, internal fixation exposure, sural nerve injury and so on. Conclusions Modified tarsal sinus incision for Sanders type Ⅲ calcaneal fracture has the advantage of convenient operation and sufficient exposure of articular surface. Fixation with mini-plate and medial column screw can prevent calcaneal varus and reduce complications after operation.
Objective To explore the minimally invasive treatment of Sanders Ⅲ calcaneal fractures with mini-plate and internal column screw. Methods The clinical data of 31 cases with Sanders type Ⅲ calcaneal fracture treated by modified tarsal sinus incision with mini-plate and medial column screw from January 2016 to December 2016 was retrospectively analyzed. Among them, there were 21 males and 10 females, aged 22～43 years, with an average age of 32.4 years. 18 were on the left and 13 on the right.Postoperative complications were counted and differences before and after operation of Bohler's angle,Gissane's angle, calcaneal height and width were compared. Finally,AOFAS(Ankle and hind foot scoring system)was used to evaluate the clinical efficacy. Results All the 31 patients were followed up from 21 to23.8 months, and the average follow-up time was 22.5 months. All patients achieved bone union, and the mean duration of fracture healing was 5.1 months. At the last follow-up, Bohler angle, Gissane angle, calcaneal height and calcaneal width were significantly different from those before operation(P<0.01). AOFAS score increased from(64.3±1.1) preoperatively to(85.7±3.2) postoperatively, of which 22 were excellent and 5 were good. There were no common complications such as wound infection, skin flap necrosis, peroneal tendon irritation, internal fixation exposure, sural nerve injury and so on. Conclusions Modified tarsal sinus incision for Sanders type Ⅲ calcaneal fracture has the advantage of convenient operation and sufficient exposure of articular surface. Fixation with mini-plate and medial column screw can prevent calcaneal varus and reduce complications after operation.
引文
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[2]杨攀,章莹,刘坚,等.锁定钢板内置和外置固定SandersⅡ型跟骨骨折的三维有限元分析[J].中国临床解剖学杂志,2014,32(6):716-720.
[3]Besch L,Waldschmidt JS,Daniels-Wredenhagen M,et al.The treatmentof intra-articular calcaneus fr actures with severe soft tissuedamage with a hinged external fi xator or internal stabilization:longtermresults[J].JFoot Ankle Surg,2010,49(1):8-15.
[4]张学全,曾金莲,曾参军,等.数字技术辅助下微创治疗Ⅱ、Ⅲ型跟骨骨折[J].实用骨科杂志,2017,23(12):1146-1149.
[5]吴根发,陈超,王志峰,等.微创内固定技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J].中国骨与关节损伤杂志,2016,31(6):666-667.
[6]颜登鲁,朱豪东,李健,等.微创内固定技术治疗跟骨骨折的基础研究[J].中国临床解剖学杂志,2007,25(5):521-524.
[7]梁晓军,赵宏谋.跟骨骨折的临床治疗要点[J].中国骨伤,2014,27(7):533-535.
[8]张晓光,袁瑞新,李东亮.微创切口与外侧L形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(4):438-439.
[9]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]杨攀,章莹,刘坚,等.锁定钢板内置和外置固定SandersⅡ型跟骨骨折的三维有限元分析[J].中国临床解剖学杂志,2014,32(6):716-720.
[3]Besch L,Waldschmidt JS,Daniels-Wredenhagen M,et al.The treatmentof intra-articular calcaneus fr actures with severe soft tissuedamage with a hinged external fi xator or internal stabilization:longtermresults[J].JFoot Ankle Surg,2010,49(1):8-15.
[4]张学全,曾金莲,曾参军,等.数字技术辅助下微创治疗Ⅱ、Ⅲ型跟骨骨折[J].实用骨科杂志,2017,23(12):1146-1149.
[5]吴根发,陈超,王志峰,等.微创内固定技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J].中国骨与关节损伤杂志,2016,31(6):666-667.
[6]颜登鲁,朱豪东,李健,等.微创内固定技术治疗跟骨骨折的基础研究[J].中国临床解剖学杂志,2007,25(5):521-524.
[7]梁晓军,赵宏谋.跟骨骨折的临床治疗要点[J].中国骨伤,2014,27(7):533-535.
[8]张晓光,袁瑞新,李东亮.微创切口与外侧L形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(4):438-439.
[9]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.