无头加压螺钉内固定术治疗SandersⅡ、Ⅲ型跟骨骨折疗效分析  

Treatment of Sanders Ⅱ、Ⅲ Types Calcaneal Fractures with Headless Forcing Screw Fixation

作　　者：李伟[1] 杨丽娜 刘金标[1] 谢美明[1] 潘显明[1] 范凌[1] 邓少林[1] 

机构地区：[1]成都军区总医院骨科,四川成都610083 [2]四川省医疗卫生技术咨询所,四川成都610041

出　　处：《四川医学》2014年第10期1267-1269,共3页Sichuan Medical Journal

基　　金：2013省卫生厅课题(编号:130325)

摘　　要：目的：评价分析无头加压螺钉内固定治疗 Sanders Ⅱ型、Ⅲ型跟骨骨折的临床特点及治疗方法。方法2009年1月至2012年9月对本院收治的跟骨骨折患者23例26足采用小切口无头加压螺钉固定治疗。术前均行跟骨轴位、侧位 X 线检查,并进行CT平扫加重建。根据Sanders分型,Ⅱ型18足,Ⅲ型8足。术后根据AOFAS后足评分标准评定功能情况。结果所有跟骨骨折于术后9~16周愈合,平均10周,术后均获得7~24个月随访,平均12．6个月,随访病例跟骨术后后关节面均无塌陷发生,X线片示Bohler角和Gissane角、跟骨外形基本恢复正常,跟骨后关节面和跟骨长度、宽度、高度均恢复满意,无内固定物并发症发生。按照美国踝足外科学会踝-后足评分标准进行评价,优14足（53．84%）,良9足（34．61%）,差3足（11．53%）,平均88．7分,优良率88.46%。4足术后发生创伤性关节炎,未发生皮肤坏死及感染。结论无头加压螺钉内固定治疗SandersⅡ型、Ⅲ型跟骨骨折具有操作简单、创伤微小、固定牢靠、并发症少、术后恢复快、疗效佳等优点,也适合治疗软组织挫伤严重、切开复位内固定禁忌的跟骨骨折患者。Objective To evaluate the results of the treatment of SandersⅡ、ⅢCalcaneal Fractures with Headless Forc-ing Screw Fixation. Methods From January 2009 to September 2012,23 cases（26 feet） of Sanders Ⅱ、Ⅲ Calcaneal Fractures were treated with Headless Forcing Screw Screw Fixations,All cases were given axial view／side position X ray examation,and CT scan. 18 patients were typeⅡand 8 patients were typeⅢby Sanders classification respectively. During follow-up,pain,functional outcome,range of motion,and change in footwear were evaluated with the use of the American Orthopaedic Foot＆amp;Ankle Society （ AOFAS） score. Results We reviewed the cases of 23 patients who had a combined total of 26 displaced intra-articular calcaneal fractures and a follow-up period of 7 to 24 months（mean 12. 6 months）. All cases showed clinical healing during 9 to 16 weeks （ mean 10 weeks） . There were No infections occurred,no failure of internal fixationin. And the subtalar arthrodesis had been per-formed in four patients. At the time of follow-up,the Bohler＆#39;s,Gissane＆#39;s angle,calcaneal width and height were reduced close to nor-mal anatomic structure in X-ray. According to AOFAS Hindfoot score,the operation results were excellent in 14 feet,good in 9,and poor in 3. The AOFAS Hindfoot Score averaged 88. 7. The overall satisfactory results（ excellent and good） were 88. 46%. Conclu-sion Headless Forcing Screw fixation of calcaneal fractures（ Sanders Ⅱ,Ⅲ） is associated withminimal soft tissue traumatization and low complication rates. It allows early rehabilitation and excellent results with proper patient selection. The procedure is suit-able for most types of intra-articular fractures especially in patients with compromised soft tissues in which open reduction and in-ternal fixation is contraindicated.

关 键 词：跟骨骨折 空心螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]