微创手术同种异体骨移植治疗压缩性跟骨关节内骨折  

Effect of minimally invasive surgery combined with allograft bone in treating compressive intra-articular calcaneal fractures

作　　者：钟伟斌[1] 柳昱[1] 黄文铎[2] 

机构地区：[1]广州医学院港湾医院骨科,广东省广州510700 [2]广州医学院第二附属医院骨科

出　　处：《中国基层医药》2009年第7期1253-1254,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨压缩性跟骨关节内骨折经外侧小切口辅助撬拨复位同种异体骨移植结合经皮克式针牵拉手法撬拨复位内固定治疗的手术特点与临床疗效。方法对17例（17足）采用经皮克式针牵拉手法复位结合距下关节外侧小切口入路撬拨复位，跟距骨克式针内固定，同种异体骨移植微创手术治疗的压缩性跟骨关节内骨折患者（Sanders分型为Ⅱ～Ⅲ型）进行回顾性分析。结果17例患者平均随访13．5个月。切口Ⅰ期愈合15足，出现明显排斥反应2足。术前Bolder角为（9．58±5．25）°，Gissane角为（101．15±13．83）°。术后即刻Bohler角为（33．55±4．17）°、Gissane角为（113．25±12．17）°；手术前后比较差异均有统计学意义（P〈0．05）。随访结束时Bolder角为（31．65±7．72）°，Gissane角为（111．15±8．68）°，与术前比较差异有统计学意义（P〈0．05），与正常值比较差异无统计学意义（P〉0．05）。结论经外侧小切口辅助撬拨复位同种异体骨移植结合经皮克式针牵拉手位撬拨复位内固定治疗Sanders Ⅱ、Ⅲ型压缩性跟骨关节内骨折创伤小、并发症少且能有效填充缺损区，维持复位后跟骨的高度，疗效满意。Objective To evaluate the surgical characteristics and clinical effect of pereutaneous reduction with kirschner wire assisted by a small lateral incision approach for peking reduction and allograft bone transplantation in treating compressive intra-articular calcaneal fractures. Methods A retrospective analysis was performed among 17 patients with compressive intra-articular caleaneal fractures （Sanders Ⅱ to Ⅲ ） treated by pereutaneous reduction with kirschner wire assisted by a small lateral incision approach for peking reduction and allograft bone transplantation. Results All the patients were followed-up for an average time of 13.5 months. The wound of 15 feet achieved primary healing, the acute rejection was found in 2 patients. The Bohler＇s angle was （9.58 ±5.25）° and Gissane angle was （ 101.15 ± 13. 83 ） ° preoperation and was （ 33.55 ± 4. 17 ） °and （ 113.25 ± 12. 17 ） ° immediate pestoperation, showing statistically significant differences pre-and postoperation（ P 〈 0. 05 ）. By the lately follow-up,the Bohler angle was （31.65 ± 7. 72 ） °and Gissane angle was （111.15 ± 8.58 ）°, also showing statistically significant differences when compared to preoperation（P 〈 0. 05 ）, there was no statistically significant differences （P 〉 0. 05 ） when compared with normal X-ray. Conclusion That pereutaneous reduction with kirschner wire assisted by a small lateral incision approach for peking reduction and allograft bone transplantation in treating the compressive intra-articular calcaneal fractures （Sanders Ⅱ to Ⅲ ） is minimally invasive, less complication, and it enables satisfactory reconstruction of bone defects and allows metanatomic reduction and functional recovery, also maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.

关 键 词：足关节 跟骨 骨折固定术 内 同种异体骨移植 

分 类 号：R687[医药卫生—骨科学]