关节镜监视辅助经皮复位螺钉内固定治疗跟骨关节内移位骨折  被引量:19

Arthroscopy-assisted percutaneous reduction and screw fixation for displaced intra-articular calcaneal fractures

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作  者:冯仕明[1] 王爱国[1] 范家强[1] 常步青 张在轶 Feng Shiming;Wang Aiguo;Fan Jiaqiang;Chang Buqing;Zhang Zaiyi(Department of Hand and Foot Microsurgery,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区:[1]徐州市中心医院手足显微外科,徐州221009

出  处:《中华医学杂志》2020年第5期367-372,共6页National Medical Journal of China

基  金:江苏省青年医学人才项目(QNRC2016393);江苏省六大人才高峰项目(2019-WSW-173);徐州市重点研发计划项目(KC18180)。

摘  要:目的 探讨跟骨关节内移位骨折的全跟距关节镜下治疗技术和临床疗效。方法 回顾性分析徐州市中心医院2015年12月至2017年12月采用改良全跟距关节镜技术治疗的46例46足跟骨关节内移位骨折患者的资料。其中男28例28足,女18例18足;年龄19~60岁,平均(39±13)岁。受伤到手术时间1~10 d,平均(4.5±2.2)d。术前患者疼痛视觉模拟评分(VAS)为4~8分,平均(6.3±1.8)分。所有患者患足无其他合并损伤。所有患者均采用跟距关节镜下前外侧、外侧、后外侧入路进行跟骨骨折的复位,并采用全螺纹空心螺钉固定,术后随访检测患者足部疼痛的缓解情况及足部外观的满意情况,并采用美国足踝外科协会踝与后足评分系统(AOFAS)及Maryland评分系统对手术治疗效果进行评价。手术前后各指标数据比较采用配对t检验。结果 术后所有切口均获一期愈合,未出现血管、神经及肌腱损伤等并发症。本组46例46足获得随访,时间12~36个月,平均(21±9)个月。术后骨折愈合时间为8~12周,平均(10.4±2.3)周。末次随访时,患者踝关节、跟距关节运动理想,未出现跟距关节创伤性关节表现,跟距关节疼痛VAS评分均为0分,AOFAS评分由术前的(58±13)分提高到(96±9)分,Maryland评分(72±11)分提高到术后的(98±8)分,均较术前有显著改善(t=15.958、12.496,均P<0.05)。结论 跟骨关节内移位骨折的全跟距关节镜下治疗技术,骨折复位精确,足部术后并发症小,疗效确切,是一种可供选择的有效治疗方法。Objective To investigate the surgical technology and clinical efficacy of using the all-inside arthroscopic treatment of intra-articular displaced calcaneal fracture.Methods A retrospective analysis was made of 46 patients(46 feet)with intra-articular displaced calcaneal fractures treated by modified all-inside arthroscopic from December 2015 to December 2017 in Xuzhou Central Hospital.Twenty-eight cases(28 feet)were male and 18 cases(18 feet)were female,aged from 19 to 60 years(mean(39±13)years).The time from injury to operation was 1 to 10 days(mean(4.5±2.2)days).The pre-operative visual analogue scale(VAS)of pain ranged from 4 to 8 points,mean(6.3±1.8)points.No other combined injuries were found in the affected feet in all patients.All patients were treated with anterolateral,lateral and posterolateral approaches of arthroscopically assisted reduction for calcaneal fractures,and fixed with hollow screw.Main outcome measures included the pain,foot appearance,and the scores of the American Orthopedic Foot&Ankle Society(AOFAS)Scale and the Maryland Scale.Paired t test was used when the data before and after the operation were compared.Results All incisions healed in one stage without postoperative complications such as nerve,vessel and tendon injury.The mean follow-up period ranged from 12 to 36 months,mean(21±9)months.Postoperatively X-ray showed complete fracture healing time was 8 to 12 weeks,mean(10.4±2.3)weeks.At the last follow-up,the ankle and talocalcaneal joints movement and appearance were ideal,and no traumatic arthritis was found.The VAS score of talocalcaneal joint was 0.AOFAS score increased from 58±13 to 96±9 and Maryland score increased from 72±11 to 98±8 after the operation,the differences were all significant(t=15.958,12.496,both P<0.05).Conclusion The all-inside arthroscopic treatment of the intra-articular displaced calcaneal fracture is an effective and precise method,with accurately outcomes,precise reduction and minimally postoperative complications.

关 键 词:跟骨关节内骨折 关节镜技术 跟距关节 螺钉固定 

分 类 号:R687[医药卫生—骨科学]

 

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