自制跟骨撑开复位器在跟骨骨折经皮微创治疗中的应用疗效分析  

Application of a self-made distraction reductor in percutaneous minimally invasive treatment of calcaneal fractures

作　　者：罗刚[1] 郭书权[1] 倪卫东[1] Luo Gang;Guo Shuquan;Ni Weidong(Department of Orthopaedics,The First Affiliated Hospital to Chongqing Medical University,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：《中华创伤骨科杂志》2021年第4期291-298,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的观察自制跟骨撑开复位器辅助经皮微创治疗跟骨骨折的疗效。方法回顾性分析重庆医科大学附属第一医院骨科2017年1月至2019年12月收治的32例(37足)跟骨骨折患者资料。其中男26例,女6例;年龄20~67岁,平均46.5岁。均通过自制三平面撑开型跟骨撑开复位器恢复跟骨的高度和长度,再微创复位移位的关节内骨折块(关节内骨折患者),最后通过微创钢板或螺钉进行固定。记录复位器的安装时间、手术时间及术中出血量;观察并发症、骨折愈合及复位情况;记录末次随访时跟骨高度、长度、宽度、美国足踝外科协会(AOFAS)的踝-后足评分、Maryland评分及疼痛视觉模拟评分(VAS),比较患者术前、末次随访时的Böhler角和Gissane角。结果所有患者术后获12~36个月(平均17.2个月)随访。复位器安装时间3~8 min(平均5.0 min),手术时间70~110 min(平均91.5 min),术中出血量15~50 mL(平均25.2 mL)。1例患者出现牵引钉道浅表感染,1例出现腓肠神经损伤。末次随访时所有骨折均愈合,无复位丢失。末次随访时跟骨高度平均为39.3 mm,长度平均为70.6 mm,宽度为32.7 mm,AOFAS的踝-后足评分平均为87.8分,Maryland评分平均为86.7分,VAS评分平均为2.2分。跟骨Böhler角由术前的3.7°±13.7°恢复至末次随访时的25.8°±6.4°,跟骨Gissane角由术前的112.2°±21.3°恢复至末次随访时的125.8°±5.7°,差异均有统计学意义(P<0.05)。结论运用自制跟骨撑开复位器辅助经皮微创治疗跟骨骨折可以取得良好的临床疗效,三平面撑开型跟骨撑开复位器是一种值得推广的跟骨骨折复位工具。Objective To evaluate our self-made distraction reductor used in the percutaneous minimally invasive treatment of calcaneal fractures.Methods A retrospective study was conducted of the 32 patients(37 feet)who had been treated at Department of Orthopaedics,The First Affiliated Hospital to Chongqing Medical University from January 2017 to December 2019 for calcaneal fractures.They were 26 males and 6 females,aged from 20 to 67 years(average,46.5 years).The height and length of the calcaneus were restored by our self-made tri-plane distraction reductor in all patients;the displaced fracture blocks were reset in a minimally invasive manner in patients with intra-articular fracture;final fixation was performed with a minimally invasive plate and screws.Time for reductor installation,operation time and intraoperative blood loss were recorded;complications,fracture union and reduction were observed;height,length and width of the calcaneus,ankle-hindfoot scores of American Society of Foot and Ankle Surgery(AOFAS),Maryland scores,and visual analogue scale(VAS)were recorded at the last follow-up;Böhler and Gissane angles were compared between pre-and post-operation.Results All patients were followed up for 12 to 36 months(average,17.2 months).Time for reductor installation averaged 5.0 min(from 3 to 8 min),operation time 91.5 min(from 70 to 110 min),and intraoperative blood loss 25.2 mL(15 to 50 mL).Superficial infection of traction track occurred in one patient and sural nerve injury in one patient.All fractures united without any reduction loss by the last follow-up.On average,the last follow-up observed a calcaneal height of 39.3 mm,a calcaneal length of 70.6 mm,a calcaneal width of 32.7 mm,an AOFAS score of 87.8,a Maryland score of 86.7 and a VAS score of 2.2.The calcaneal Böhler angle was recovered significantly from 3.7°±13.7°preoperatively to 25.8°±6.4°at the last follow-up,and the calcaneal Gissane angle from 112.2°±21.3°preoperatively to 125.8°±5.7°at the last follow-up(P<0.05).Conclusion In percutan

关 键 词：跟骨 骨折 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]