自制导向器引导螺钉固定跟骨骨折  

A self-developed guider introducing screw placement for internal fixation of calcaneus fractures through sinus tarsi approach

作　　者：付强 吴刚 兰生辉 魏世隽 徐峰 蔡贤华 FU Qiang;WU Gang;LAN Sheng-hui;WEI Shi-jun;XU Feng;CAI Xian-hua(Department of Orthopaedics,General Hospital of PLA Central Theater Command,Wuhan 430070,China)

机构地区：[1]解放军中部战区总医院骨科足踝与运动医学中心(湖北省骨创伤救治临床医学研究中心),湖北武汉430070

出　　处：《中国矫形外科杂志》2020年第16期1445-1449,共5页Orthopedic Journal of China

基　　金：湖北省自然科学基金项目(编号:2017CFB568)。

摘　　要：[目的]评价经跗骨窦入路自制导向器引导螺钉置入固定跟骨骨折的临床效果。[方法]回顾性分析2014年8月~2018年2月本院经跗骨窦入路开放复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折65例患者。其中,35例采用自制导向器引导下置入螺钉(导向器组),30例采用常规徒手技术置入螺钉(非导向器组)。比较两组临床与影像资料。[结果]两组患者均顺利完成手术。导向器组术中导针调整次数、术中透视次数和手术时间均显著优于非导向器组(P<0.05)。早期并发症导向器组共4例次(11.43%),非导向器组共6例次(20.00%),差异有统计学意义(P<0.05)。术后随访12~36个月,末次随访时,两组间VAS和AOFAS评分的差异无统计学意义(P>0.05)。影像方面,置钉错误导向器组发生率0%;非导向器组发生率16.67%,差异有统计学意义(P<0.05)。至末次随访时,两组B?hler角和Gissane角的差异无统计学意义(P>0.05)。[结论]使用自制柱螺钉导向器提高了跟骨柱螺钉经皮置入的精度,减少了术中透视次数,缩短了手术时间。[Objective]To evaluate the clinical outcomes of a self-developed guider introducing screw placement for internal fixation of calcaneus fracture through sinus tarsi approach.[Methods]A retrospective study was conducted on 65 patients who received open reduction and internal fixation(ORIF)for Sanders type II and III calcaneal fractures from August 2014 to February 2018.Of them,35 patients had screws placed with the self-developed guider(the guider group),while the remaining 30 patients had screws inserted by conventional free hand technique(the non-guider group).The clinical and radiographic documents were compared between the two groups.[Results]All the patients in both groups had ORIF conduced successfully.The guider group proved significantly superior to the non-guider group regarding to times of pin adjustment,intraoperative fluoroscopic frequency and operation time(P<0.05).The total case-time of early complication was of 4(11.43%)in the guider group,whereas 6(20.00%)in the non-guider group,which was statistically significant(P<0.05).The patients were followed up for 12~36 months,and had no statistical differences between them in VAS and AOFAS scores at the latest follow up(P>0.05).With respect to radiographic assessment,the ratio of poor placement of screw was 0 in the guider group,while 16.67%in the non-guider group,which proved statistically significant(P<0.05).However,there were no statistical differences in B?hler and Gissane angles at the latest follow up between the two groups(P>0.05).[Conclusion]This self-developed guider does improves the efficiency of screw placement,reduce intraoperative fluoroscopy times,and shortens the operation time.

关 键 词：跟骨骨折 开放复位内固定 导向器 微创性手术 

分 类 号：R683.42[医药卫生—骨科学]