交叉中空螺钉内固定治疗跟骨关节内骨折的临床疗效  

Clinical efficacy of crossing cannulated screw fixation for treatment of intra-articluar calcaneal fractures

作　　者：李坤 尹伟忠[1] 丁菊红[1] 冯铁男[2] 倪明 

机构地区：[1]上海市浦东新区人民医院骨科,201299 [2]上海交通大学公共卫生学院 [3]上海光华中西医结合医院骨科

出　　处：《中华创伤杂志》2017年第10期918-924,共7页Chinese Journal of Trauma

基　　金：上海市卫计委青年基金（20134Y207,20144Y0249）

摘　　要：目的探讨交叉中空螺钉内固定治疗跟骨关节内骨折的临床疗效。方法采用回顾性病例对照研究分析2012年7月-2015年6月收治的65例（72侧）跟骨关节内骨折患者临床资料，其中男63例，女2例；年龄18～70岁[（45．7±12．2）岁]。根据Sanders分型：Ⅱ型49侧（Ⅱa型25侧，Ⅱb型17侧，Ⅱe型7侧），Ⅲ型23侧（Ⅲab型12侧，Ⅲac型6侧，Ⅲbc型5侧）。根据手术方法分为微创组（30侧）和对照组（42侧）。微创组采用经皮或微创复位交叉中空螺钉内固定，对照组采用切开复位钢板螺钉内固定。比较两组住院时间、骨折复位和愈合情况、术后功能及并发症发生率。跟骨形态依据其长、宽、高、B？hler角和Gissane角判断，足部功能依据美国足踝外科协会（AOFAS）踝-后足功能评分评价。结果患者均获随访6-24个月[（15．2±4．7）个月]。骨折均I期愈合。微创组住院时间较对照组明显缩短[（10．2±2．3）d：（18．6±3．3）d]（P〈0．05）。术后与末次随访比较，微创组跟骨宽、B？hler角的变化小于对照组（P〈0．05）。微创组与对照组中Sanders Ⅱ型骨折患者的AOFAS踝-后足评分分别为（89．3±6．8）分、（90．1±8．1）分（P〉0．05）；Sanders Ⅲ型评分分别为（83．5±10．8）分、（82．5±7．3）分（P〉0．05）。微创组并发症发生率为20％，对照组为19％（P〉0．05）。结论与钢板内固定比较，交叉中空螺钉内固定治疗跟骨关节内骨折具有更好的稳定性、创伤小、住院时间短等优点，有助于促进后足功能恢复，可作为非严重粉碎性跟骨骨折的首选治疗方案。Objective To assess the clinical results of crossing cannulated screw fixation for intra-articular calcaneal fractures. Methods A total of 65 patients （72 sides） were retrospectively studied from July 2012 to June 2015 by case-control study, including 63 males and two females at age range of 18-70 years [ （45.7± 12.2 ）years]. According to the Sanders classification, there were 49 fractures of type Ⅱ （25 type Ⅱa, 17 type Ⅱb, 7 type Ⅱc） and 23 fractures of type Ⅲ（ 12 type Ⅲab, 6 type Ⅲac, 5 type Ⅲ bc）. The cases had been divided into two groups, namely, the crossing cannulated screw fixation group （ CCSFG group, 30 cases ） and plate fixation group （ PFG group, 42 cases）. The results were compared with regard of the hospitalization time, fracture reduction and union, AOFAS score system, and complications. The calcaneal shape was assessed by the length, width, height, B？hler angle and Gissane angle. The foot function was assessed by the American Orthopedic Foot and Ankle Society （AOFAS） ankle-hind foot score system. Results All were followed up for 6-24 months [ （ 15.2±4. 7）months], and presented fracture healing. The time of hospitalization was （10. 2 ± 2. 3 ）days （7-14 days） and （18.6 ±3.3）days （13-28 days） in CCSFG and PFG groups, respectively（P 〈0. 05）. At the first and final visits during follow-up, the changes in calcaneal width and B？ihler angle of CCSFG group were smaller than that of PFG group （ P 〈 0.05 ）. For Sanders Ⅱ type cases, the average AOFAS function scores in CCSFG and PFG groups were （ 89. 3± 6. 8 ） points and （ 90. 1 ＋ 8. 1 ） points, respectively （ P 〉 0.05 ）. For Sanders type Ⅲ cases, the corresponding scores in CCSFG and PFG groups were （83.5 ± 10.8） points and （82.5±7.3）points, respectively （P 〉0.05）. The complication rate in the CSFG and PFG groups was 20% and 19%, respectively （P 〉 0.05 ）. Conehmions Compared with the plate fixation, the crossing eannulated screw fix

关 键 词：跟骨 骨折固定术 内 对比研究 

分 类 号：R687.3[医药卫生—骨科学]