自制骨科导向复位钳在载距突螺钉置入应用  

Self-developed forceps for fracture reduction and guiding sustentaculum tali screw insertion used for calcaneal fractures

作　　者：段强民[1] 李光磊[1] 张冰[1] 王宝鹏[1] 关育忠 王冠 孙全省 吕新凯 蔡梦洋 张汉宽 DUAN Qiang-min;LI Guang-lei;ZHANG Bing;WANG Bao-peng;GUAN Yu-zhong;WANG Guan;SUN Quansheng;LV Xin-kai;CAI Meng-yang;ZHANG Han-kuan(Department of Orthopaedics,Zibo Municipal Hospital,Binzhou Medical College,Zibo 255400,China)

机构地区：[1]滨州医学院附属淄博市市立医院骨一科,山东淄博255400

出　　处：《中国矫形外科杂志》2020年第16期1511-1514,共4页Orthopedic Journal of China

摘　　要：[目的]介绍跟骨关节内骨折手术治疗时使用自制骨科导向复位钳辅助载距突螺钉手术技术的初步疗效。[方法]2016年1月~2019年8月开放复位内固定治疗跟骨关节内骨折41例(43足)。所有手术均采用跗骨窦与跟骨后外侧联合切口,术中使用自制骨科导向复位钳辅助置入跟骨载距突螺钉。[结果]41例患者均顺利手术,切口均I期愈合,无感染和皮缘坏死及不愈合发生。末次随访时Maryland足功能评分(89.09±5.37)分,术后CT扫描显示2枚载距突螺钉部分螺纹自距下关节中关节面穿出;1例自载距突前侧穿出,准确率为93.02%(40/43)。与术前相比,术后CT间隙显著减少,而贝氏角和盖氏角显著增加(P<0.05)。[结论]骨科导向复位钳能辅助术者准确完成载距突螺钉置钉,并可减少冠状面骨折间隙。[Objective]To introduce surgical technique and primary clinical outcomes of the sustentaculum tali screw placement by using a self-made forceps for Sanders typeⅡandⅢcalcaneal fractures.[Methods]From January 2016 to August 2019,41 patients(43 feet)underwent open reduction and internal fixation for intra-articular calcaneal fractures.During operation,a tarsal sinus incision and the posterolateral calcaneal incision were combined for surgical interference,a sustentaculum tali screw was inserted under guiding with self-made forceps to enhance fracture reduction and fixation.[Results]All the43 feet got successful operation and primary incision healing without complications,such as poor incision healing,skin necrosis and infection,in anyone of them.The Maryland score was of(89.09±5.37)at the latest follow up.In term of radiographic assessment,all sustentaculum tali screws were placed in proper position revealed by CT scanning postoperatively,except 2 penetrated at middle part of subtalar joint surface,and 1 penetrated anterior to the sustentaculum tali,with placement accuracy of 93.02%(40/43).The fracture gap on coronal plane significantly decreased,while the B?hler angle and Gissane angle significantly increased after operation compared with those before operation(P<0.05).[Conclusion]The self-developed forceps do facilitate placement of sustentaculum tali screw to enhance fracture reduction and fixation for calcaneal fractures.

关 键 词：跟骨骨折 开放复位内固定 导向复位钳 

分 类 号：R683.42[医药卫生—骨科学]