跟骨反牵复位器结合横向螺钉固定治疗跟骨骨折
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摘要
目的：跟骨骨折因跟骨与周围解剖结构复杂,长期以来跟骨骨折的治疗效果不能令人满意,近年来跟骨骨折治疗预后有了较大改观,但仍然有许多问题仍未解决,特别是各种关节内骨折,缺乏适用于各种类型骨折的可靠内固定物,缺乏安全入路等,其并发症高也是无法避免。本研究通过观察反牵复位器结合横向螺钉固定治疗跟骨骨折的疗效,综合评价该治疗方法的临床价值,为治疗跟骨骨折提出一种新的治疗方法.
方法：选择符合诊断标准的跟骨骨折患者42例50足,采用跟距反牵复位器结合横向螺钉固定治疗。经过临床应用和随访效果满意,跟骨塌陷关节面复位,Bohler角恢复,跟骨宽度恢复,优良率89.2%。
结论：反牵复位器结合横向螺钉固定治疗跟骨骨折与国内外同类技术比较具有创伤小、并发症少、复位效果好的优势,综合评价优于目前其他治疗方法,居国内领先水平。
Objective:The therapeutic efficacy to fracture of calcaneus has been unsatisfactory ever since a long time ago because of the complicated anatomic structure,Although the therapeutic efficacy has improved greatly,but there are many questions have not been solved especially in various intraarticular fractures,it's high complication can not be avoided because of the lack of reliable internal fixation and safe approach.This research appraise the clinical value of fixing fracture of calcaneus with anti-pull repositor and transversal bolt by observing it's curative effect,and raise a new method to fracture of calcaneus.
Method:Choosing 42 fracture of calcaneus suffers with 50 foots by rigorous internalizing standard and depleting standard,fix the fracture of calcaneus with anti-pull repositor and transversal bolt,find out that it's effect is satisfactory,the joint surface can be repositioning,the Bohler angulations and the width of calcaneus can be recovered, superordinary rate attain 89.2%.
Conclusion:Fixing fracture of calcaneus with anti-pull repositor and transversal bolt is better than other methods to fracture of calcaneus because of smaller trauma, fewer complication and better reposition, it's synthetic evaluation is surpass others methods and advance in our country.
方法：选择符合诊断标准的跟骨骨折患者42例50足,采用跟距反牵复位器结合横向螺钉固定治疗。经过临床应用和随访效果满意,跟骨塌陷关节面复位,Bohler角恢复,跟骨宽度恢复,优良率89.2%。
结论：反牵复位器结合横向螺钉固定治疗跟骨骨折与国内外同类技术比较具有创伤小、并发症少、复位效果好的优势,综合评价优于目前其他治疗方法,居国内领先水平。
Objective:The therapeutic efficacy to fracture of calcaneus has been unsatisfactory ever since a long time ago because of the complicated anatomic structure,Although the therapeutic efficacy has improved greatly,but there are many questions have not been solved especially in various intraarticular fractures,it's high complication can not be avoided because of the lack of reliable internal fixation and safe approach.This research appraise the clinical value of fixing fracture of calcaneus with anti-pull repositor and transversal bolt by observing it's curative effect,and raise a new method to fracture of calcaneus.
Method:Choosing 42 fracture of calcaneus suffers with 50 foots by rigorous internalizing standard and depleting standard,fix the fracture of calcaneus with anti-pull repositor and transversal bolt,find out that it's effect is satisfactory,the joint surface can be repositioning,the Bohler angulations and the width of calcaneus can be recovered, superordinary rate attain 89.2%.
Conclusion:Fixing fracture of calcaneus with anti-pull repositor and transversal bolt is better than other methods to fracture of calcaneus because of smaller trauma, fewer complication and better reposition, it's synthetic evaluation is surpass others methods and advance in our country.
引文
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[8]俞光荣,燕晓宇.跟骨骨折治疗方法的选择.中华骨科杂志,2006,2(26)：134-141.
[9]王战朝,李金明.跟骨关节内骨折后遗症原因分析及其治疗.中国中医骨伤科杂志,1998,6(5)：36-39.
[10]唐三元,徐永年,郑玉明.跟骨骨折(二).中国矫形外科杂志,1998,5(2)：169-170.
[11]顾湘杰,章永德,任颂扬,等.累及距跟关节的粉碎性骨折的亚急诊手术治疗.中华骨科杂志,1992,3(12)：190～193.
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[19]黄洪斌,鲍丰,张根福,等.跟骨骨折术后创口不愈合原因分及对策.中华创伤骨科杂志,2005,3(7)：294-295.
[20]张家红,董海,戴力杨.跟骨关节内骨折的手术治疗.临床骨科杂志,2001,4：135-136.
[21]魏巍.骨圆针撬拨复位治疗跟骨骨折的临床观察.中华临床医学杂志,2005,5(6)：24-25.
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[2]《中医病症诊断疗效标准》.国家中医药管理局,1995,第一版：11.
[3]徐少订,葛宝丰,徐印坎.实用骨科学[M]. 北京：人民卫生出版社,2003,第二版：422-423.
[4]Essex-Lopresti P. The mechanism, reduction technique, and result in fractures of the os calcis.Br J Surg,1952,39:395-419.
[5]Sanders R, Fortin P, DiPasquale A, et al. Operatment in 120 displaced intra-articular calcaneal fractures:results using a prognostic computed tomography scan classification. Clin Orthop Relat Res,1993, (290):87-95.
[6]Adams CI, Keating JF, Court-Brown CM. Cigarette smoking and open tibiafractures[J]. Injury,2001,32:61-65.
[7]张铁良,于建华.跟骨关节内骨折.中华骨科杂志,2000,2(20)：117-120.
[8]俞光荣,燕晓宇.跟骨骨折治疗方法的选择.中华骨科杂志,2006,2(26)：134-141.
[9]王战朝,李金明.跟骨关节内骨折后遗症原因分析及其治疗.中国中医骨伤科杂志,1998,6(5)：36-39.
[10]唐三元,徐永年,郑玉明.跟骨骨折(二).中国矫形外科杂志,1998,5(2)：169-170.
[11]顾湘杰,章永德,任颂扬,等.累及距跟关节的粉碎性骨折的亚急诊手术治疗.中华骨科杂志,1992,3(12)：190～193.
[12]王京彦,徐怀安,单素鸿.可调性跟距反牵复位固定器治疗跟骨骨折.中国骨伤,1994,7(1)：28～29.
[13]汤荣光,盛为,戴克戎.距下关节接触特征及其临床意义.中华骨科杂志,1999,19(8)：484.
[14]Abidi NA, DhawanS, Gruen GS, et al, Foot Ankleint,1998,19(12):856-861.
[15]Benirschke SK, Kramer PA, JOrthop Trauma,2004,18(11):1-6.
[16]高质钢,张浩,薛静.U型外固定架结合闭合手法复位治疗跟骨骨折.中华骨科杂志,2004,1(24)：19-21.
[17]Rammelt S, zwipp H. Calcaneus fractures:facts, controversies andrecent developments. Injury,2004,35:443-461.
[18]赵亮,刘长贵,王宝军.跟骨关节内骨折的钢板内固定治疗疗效及并发症分析.中华创伤骨科杂志,2005,3(7)：239-241.
[19]黄洪斌,鲍丰,张根福,等.跟骨骨折术后创口不愈合原因分及对策.中华创伤骨科杂志,2005,3(7)：294-295.
[20]张家红,董海,戴力杨.跟骨关节内骨折的手术治疗.临床骨科杂志,2001,4：135-136.
[21]魏巍.骨圆针撬拨复位治疗跟骨骨折的临床观察.中华临床医学杂志,2005,5(6)：24-25.
[1]Miric A, Patterson BM. Pathoanatomy of intra-articular fractures of the calcaneus [J]. J Bone and Joint Surg,1998;80 A (2):207-212.
[2]梁军,胡滨成.跟骨的形态结构特点及其临床意义. 中国临床解剖学杂志,2000：2(18),118-120.
[3]Carr JB, Hamilton JJ. Experimental intra-articular calcaneal fractures: Anatomic basis for anew classification [J]. Foot Ankle,1989; 10:81-87.
[4]Hall RH, Shereff MJ. Anatomy of the calcaneus [J]. Clin Orthop 1993:290:27-35.
[5]Borowsky KA. Two case reports of a technique of a technique of medial external fixation in calcaneal fractures:indirect control of the sustentacular fragment [J]. Foot and Ankle Internat,1996;17(4): 210-216.
[6]俞光荣,梅炯,袁锋,等.跟骨的解剖分部及其临床意义.中国临床解剖学杂志,2001;19(4)：299-311.
[7]Essex-Lopresti P. The mechanism, reduction, technique, and results in fractures of the os calcis [J]. British J Surg,1952;39:395-419.
[8]Burdeaux BD. Reduction of calcaneal fractures by the Mc Reynolds medial approach technique and its experimental basis [J]. Clin orthop, 1983;177:87-103.
[9]Thoren o. Os calcis fractures[J]. Acta orthop. Scandinavica, Supplementum,1964;70.
[10]Johnson EE. Diagnosis and surgicall treatment of m intraarticular calcaneus fracture[J]. Orthopedics,1991;13(10):1091-1100.
[11]顾湘杰,陈劲松,鲍根喜,等.三维CT建对跟骨骨折治疗的临床意义.中国医学计算机成像杂志,2000：6,(2)：113-115.
[12]Essex-Lopresti P.The mechanism, reduction technique,and result in fractures of the os calcis. Br J Surg,1952,39:395-419.
[13]Sanders R, Fortin P, DiPasquale A, et al.Operatment in 120 displaced intra-articular calcaneal fractures:results using a prognostic computed tomography scan classification. Clin Orthop Relat Res,1993, (290):87-95.
[14]Zwipp H, Tscherne H, Thermann H, et al. Osteosynthesis of displayced intraarticular fractures of the calcaneus:results in 123 cases. Clin Orthop Relat Res,1993, (290):76-86.
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