使用自制跟骨撑开复位器经皮螺钉关键点固定治疗移位型跟骨关节内骨折  

Self-made calcaneal distraction device and percutaneous screw fixation at the key points for treatment of displaced intra-articular calcaneal fractures

作　　者：罗刚[1] 胡宁[1] 郭书权[1] 倪卫东[1] Luo Gang;Hu Ning;Guo Shuquan;Ni Weidong(Department of Orthofieclics,First Ajfiliaied Hospital of Chongqing Medical Uniwrsity,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,400016

出　　处：《中华创伤杂志》2020年第10期912-919,共8页Chinese Journal of Trauma

摘　　要：目的比较运用自制跟骨撑开复位器经皮螺钉关键点固定和传统切开复位钢板内固定治疗移位型跟骨关节内骨折(DIACFs)的临床疗效。方法采用回顾性病例对照研究分析2015年1月—2019年1月重庆医科大学附属第一医院骨科收治的60例(69足)DIACFs患者临床资料,其中男51例,女9例;年龄22~61岁[(47.2±8.7)岁]。根据Sanders分型:Ⅱ型42足,Ⅲ型15足,Ⅳ型12足。根据Essex-Lopresti分型:舌形骨折43足,关节面塌陷型23足,无法分型3足。30例(35足)采用自制跟骨撑开复位器辅助、经皮或经跗骨窦入路复位、经皮螺钉关键点固定治疗(A组),30例(34足)采用传统扩大外侧入路切开复位钢板内固定治疗(B组)。比较两组术前等待时间、手术时间、住院时间、末次随访时的骨折复位及愈合情况、美国足踝外科协会(AOFAS)评分、Maryland评分、视觉模拟评分(VAS)及切口愈合相关并发症的发生率。复位质量通过跟骨高度、长度、宽度及Böhler角评估。结果患者均获随访12~48个月[(28.2±11.3)个月]。A组术前等待时间为(3.4±1.3)d,低于B组的(6.9±1.9)d(P<0.05);A组手术时间为(91.7±10.3)min,B组为(92.8±11.5)min(P>0.05);A组住院时间为(7.0±1.4)d,低于B组的(12.7±1.7)d(P<0.05)。末次随访时,骨折均愈合,无复位丢失。A组跟骨高度为(48.9±2.0)mm,B组为(49.3±2.6)mm(P>0.05);A组跟骨长度为(83.2±2.9)mm,B组为(83.5±2.7)mm(P>0.05);A组跟骨宽度为(35.8±2.3)mm,B组为(35.1±1.3)mm(P>0.05);A组Bhler角为(24.7±6.4)°,B组为(25.9±5.8)°(P>0.05)。末次随访时,A组AOFAS评分为(87.1±8.5)分,B组为(86.7±7.8)分(P>0.05);A组优良率为89%(31/35),B组为88%(30/34)(P>0.05)。A组Maryland评分为(85.3±9.5)分,B组为(84.9±9.5)分(P>0.05);A组优良率为86%(30/35),与B组85%(29/34)(P>0.05)。A组VAS为(2.3±1.5)分,B组为(2.5±1.5)分(P>0.05)。A组无切口愈合相关并发症;B组1足出现切口浅表感染,3足出现切缘皮肤坏死,1足出现深部感染(P<Objective To compare the clinical outcomes of percutaneous screw fixation at the key points using a self-made calcaneal distraction device with traditional open reduction plate internal fixation for the treatment of patients with displaced intra-articular calcaneal fractures(DIACFs).Methods A retrospective case-control study was made on clinical data of 60 patients(69 feet)with DIACFs admitted to First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2019.There were 51 males and 9 females,with an average age of 47.2 years[(47.2±8.7)years].According to the Sanders classification,there were 42 feet of type II,15 feet of type III and 12 feet of type IV.According to the EssexLopresti classification,there were 43 feet of tongue type fractures and 23 feet of joint depression fractures.Another 3 feet were not applicable to this classification system.In Group A,30 patients(35 feet)were treated by percutaneous reduction or reduction using tarsal sinus approach with the selfmade calcaneal distraction device followed by percutaneous screw fixation.In Group B,30 patients(34 feet)were treated by open reduction and internal fixation with plates using the traditional extended lateral approach.Waiting time for surgery,operation time,length of hospital stay,efficacy of reduction and fracture healing,American Orthopedic Foot and Ankle Society(AOFAS)score,Maryland score,visual analog scale(VAS),and incidence of surgical site related complications were compared between groups.The efficacy of reduction was evaluated by measuring the height,length and width as well as the Böhler angle of the calcaneus.Results All patients were followed up for an average of 28.2 months[(28.2±11.3)months].The waiting time for surgery in Group A was(3.4±1.3)days,significantly shorter than that in Group B[(6.9±1.9)days](P<0.05).The operation time was(91.7±10.3)minutes in Group A and(92.8±11.5)minutes in Group B(P>0.05).The length of hospital stay in Group A was(7.0±1.4)days,significantly shorter than that

关 键 词：跟骨 关节内骨折 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]