跟骨骨折内固定手术中跟骨前部螺钉的置钉策略研究  

Strategy for anterior calcaneus screws placement in surgery of internal fixation for calcaneus fractures:a ra-dioanatomic study

作　　者：吴世奇 WU Shiqi(The First People’s Hospital of Jining,Jining 272000,Shandong,China)

机构地区：[1]济宁市第一人民医院,山东济宁272000

出　　处：《中医正骨》2021年第5期19-23,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨跟骨骨折内固定手术中跟骨前部螺钉的置钉策略。方法:选择40例单侧跟骨骨折患者,男25例、女15例。选择患者的健侧跟骨CT影像进行研究,在影像存储与传输系统中测量跟骰关节及载距突的各项解剖参数,包括跟骰关节横径、跟骰关节后斜角、载距突前后径、载距突上斜角、载距突上下径及载距突螺钉最大长度。结果:男性的跟骰关节横径、载距突螺钉最大长度均大于女性[跟骰关节横径:(22.40±1.86)mm,(19.97±1.80)mm,t=4.043,P=0.000;载距突螺钉最大长度:(52.45±3.99)mm,(44.81±2.18)mm,t=6.817,P=0.000];男性和女性的跟骰关节后斜角、载距突前后径、载距突上斜角、载距突上下径比较,组间差异均无统计学意义[跟骰关节后斜角:21.05°±4.42°,21.13°±3.52°,t=-0.060,P=0.952;载距突前后径:(17.85±2.41)mm,(16.49±1.88)mm,t=1.865,P=0.070;载距突上斜角:33.49°±4.76°,35.09°±5.11°,t=-0.999,P=0.324;载距突上下径:(13.59±1.84)mm,(12.79±1.35)mm,t=1.464,P=0.151]。载距突基底部截面沿其轴线投射到跟骨外侧壁的区域为跟骨前部置入载距突螺钉的理想区域,其前缘为跟骰关节面、下缘为跟骨外侧壁下缘,面积≈载距突上下径×载距突前后径。结论:跟骨骨折内固定手术中在跟骨前部置入螺钉时,可通过在CT图像中测量跟骰关节后斜角和跟骰关节横径确定进钉角度和螺钉长度;自跟骨前部向载距突置入螺钉时,进钉点的理想区域为跟骨外侧壁前下方,进钉时需同时在横断面和冠状面调整进钉角度,沿载距突轴线置入螺钉时所需螺钉最长;男性患者的跟骨前部螺钉长度和载距突螺钉最大长度均大于女性患者。Objective:To explore the strategy for anterior calcaneus screws placement in surgery of internal fixation for treatment of calcaneus fractures.Methods:Forty patients(25 males and 15 females)with unilateral calcaneus fractures were selected,and their CT imagings of the uninjured calcaneus were obtained for study.The anatomical parameters,including transverse diameter of calcaneocuboid joint,back bevel angle of calcaneocuboid joint,anteroposterior diameter(APD)of sustentaculum tali,upper bevel angle of sustentaculum tali,suprainferior diameter(SID)of sustentaculum tali and maximum length of screw required for optimal fixation of sustentaculum tali,were measured in picture archiving and communication system(PACS).Results:The transverse diameter of calcaneocuboid joint and maximum length of screw required for optimal fixation of sustentaculum tali were greater in male patients compared to female patients(22.40±1.86 vs 19.97±1.80 mm,t=4.043,P=0.000;52.45±3.99 vs 44.81±2.18 mm,t=6.817,P=0.000).There was no statistical difference in back bevel angle of calcaneocuboid joint as well as APD,upper bevel angle and SID of sustentaculum tali between the male patients and the female patients(21.05±4.42 vs 21.13±3.52 degrees,t=-0.060,P=0.952;17.85±2.41 vs 16.49±1.88 mm,t=1.865,P=0.070;33.49±4.76 vs 35.09±5.11 degrees,t=-0.999,P=0.324;13.59±1.84 vs 12.79±1.35 mm,t=1.464,P=0.151).The optimal region for implanting screws from the anterior part of calcaneus to sustentaculum tali was the area where the basal section of susten-taculum tali projected onto the lateral wall of calcaneus along its axis,and its leading edge was the calcaneocuboid joint surface and lower edge was the lower margin of calcaneal lateral wall,and its area was approximately equal to SID of sustentaculum tali multiplied by APD of sustentaculum tali.Conclusion:The angulation and length of the implanted screws can be confirmed by measuring the back bevel angle and transverse diameter of calcaneocuboid joint on CT imagings when implanting screws to the a

关 键 词：跟骨 骨折固定术 内 骨钉 跟骰关节 载距突 

分 类 号：R687.3[医药卫生—骨科学]