双螺杆撑开器辅助开放复位治疗SandersⅡ、Ⅲ型跟骨骨折  

Double screw distractor assisted open reduction and internal fixation for Sanders Type Ⅱ and Ⅲcalcaneal fractures

作　　者：朱成明[1] 王仁崇[1] 覃永保 胡居正[1] 石展英[1] ZHU Cheng-ming;WANG Ren-chong;QIN Yong-bao;HU Ju-zheng;SHI Zhan-ying(Department of Orthopedics,Liuzhou Workers Hospital,The Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,China)

机构地区：[1]柳州市工人医院/广西医科大学第四附属医院骨科,广西柳州545005

出　　处：《中国矫形外科杂志》2020年第8期751-754,共4页Orthopedic Journal of China

基　　金：广西重点研发计划项目(编号:AB17129001)。

摘　　要：[目的]介绍应用双螺杆骨折撑开器辅助切开复位锁定钢板内固定治疗跟骨SandersⅡ、Ⅲ型骨折的操作方法和初步疗效。[方法] 2016年2月~2017年5月,本院收治的14例(14足)粉碎性跟骨骨折患者,采用跟骨外侧"L"型切口,术中使用内外侧双螺杆骨折撑开器辅助复位,置入跟骨锁定钢板固定。[结果] 14例患者均顺利手术,无腓肠神经损伤。随访12~16个月。末次随访时AOFAS踝-后足评分为61~96分,其中优7例,良6例,可1例,优良率为92.86%(13/14)。影像方面,Bohle角由术前(14.14±5.58)°显著增加至术后(28.14±5.77)°(P<0.05),Gissan角由术前(106.64±8.81)°显著增加至术后(124.36±5.70)°(P<0.05)。所有骨折末次随访时均已愈合,无内固定松动、退钉、断钉等发生。[结论]使用双螺杆撑开器辅助复位治疗跟骨SandersⅡ、Ⅲ型骨折,可以有效恢复跟骨高度,避免骨折复位再丢失,简化操作,减少手术并发症。[Objective] To introduce surgical technique and primary clinical outcomes of a double screw distractor used in open reduction and internal fixation(ORIF) of Sanders type Ⅱ and Ⅲ calcaneal fractures. [Methods] From February 2016 to May 2017, 14 patients(14 feet) with comminuted calcaneal fractures were admitted into our hospital, and were surgically treated. After exposure of the calcaneus fractures through traditional L-shaped incision on the lateral side, a double-screw external distractor was set up to assist fractures reduction. After the satisfactory reduction achieved on fluoroscopy, the Kirschner’ wire was temporarily inserted, followed by the calcaneal locking plate placed for solid fixation. [Results] All the 14 patients had operations performed successfully without sural nerve injuries, and followed up for 12~16 months. At the latest follow up, the AOFAS score ranged from 61 to 96, correspondingly, the clinical outcomes were graded as excellent in 7, good in 6 and fair in 1 patient, with the excellent and good rate of 92.86%(13/14). Regarding to radiographic assessment, the Bohle angle significantly increased from(14.14±5.58)° preoperatively to(28.14±5.77)° postoperatively(P<0.05), in addition, the Gissan angle also significantly increased from(106.64±8.81)° preoperatively to(124.36±5.70)° postoperatively(P<0.05). To the latest follow up, bony healing got in all the patients without loosening, withdrawing and breaking of the implants. [Conclusion] For open reduction and internal fixation of Sanders type Ⅱ and Ⅲ calcaneal fractures, this double screw distractor does facilitate to restore the heel height, avoid the loss of reduction, simplify operation and reduce the surgical complications.

关 键 词：跟骨骨折 螺杆撑开器 开放复位内固定 

分 类 号：R683.42[医药卫生—骨科学]