推挤螺钉复位技术——一种跟骨骨折复位的新方法  

Pushing screws reduction technique——A novel method for calcaneal fracture reduction

作　　者：史元祯 王一帆 李正勋[1] 刘仲论 张煜康 刘恒志 张宁[1] 胡勇[1] SHI Yuanzhen;WANG Yifan;LI zhengxun;LIU Zhonglun;ZHANG Yukang;LIU Hengzhi;ZHANG Ning;HU Yong(Department of Foot and Ankle Surgery,the Second Hospital of Shandong Hospital,Jinan,250033,Shandong,China)

机构地区：[1]山东大学第二医院足踝外科,山东济南250033

出　　处：《足踝外科电子杂志》2024年第3期23-28,共6页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的设计一种用于辅助SandersⅡ、Ⅲ型跟骨关节内骨折内侧壁复位的推挤螺钉复位技术,并探讨此方法的疗效。方法自2020年10月至2021年10月山东大学第二医院使用推挤螺钉复位技术辅助复位SandersⅡ、Ⅲ型跟骨骨折12例,记录手术时间,对术前、术后即刻、术后6个月的跟骨宽度、Böhler角和Gissane角进行比较,应用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分评价术后疗效,评估手术相关的并发症。结果手术时间40~50 min,平均(45.0±3.4)min。12例患者术后均获得12个月以上随访,切口均一期愈合,无切口皮缘坏死和感染、腓骨长短肌肌腱炎,未出现骨折移位、内固定失败或畸形愈合等情况,均有一定程度的距下关节僵硬。与术前相比,术后即刻和术后6个月随访时跟骨宽度显著降低,Böhler角和Gissane角显著增大,差异有统计学意义(P<0.05);同时与对侧比较,跟骨长度、宽度及Böhler角和Gissane角的变化差异无统计学意义(P>0.05);与术后即刻相比,术后6个月随访时跟骨宽度、Böhler角和Gissane角的变化差异无统计学意义(P>0.05);术后6个月随访,AOFAS评分较术前显著改善。结论推挤螺钉复位跟骨骨折的技术是一种用于辅助跟骨关节内骨折内侧壁复位的有效方法,有操作简单、手术时间短、并发症少、角度改善显著等优势。Objective To design a reduction method of pushing screws for the assisted reduction of medial wall in intraarticular calcaneal fractures of SandersⅡandⅢ,and explore the efficacy of this method.Methods Twelve patients with SandersⅡandⅢcalcaneal fracture from October 2020 to October 2021 were assisted restored by pushing screws reduction method in the Second Hospital of Shandong Hospital.Recorded operation time;compared calcaneal width,Böhler’s angle and Gissane’s angle preoperatively and postoperatively(immediately and 6 months);evaluated postoperative functional recovery according to the Ankle and Hind-foot Score of American Orthopedic Foot and Ankle Surgery(AOFAS);assessed the surgery-related complications.Results The operation lasted 40 to 50 minutes,with average(45±3.4)minutes.All the 12 patients were followed up for more than 12 months.All cases gain primary incision healing,without complications including skin necrosis,wound infection,tendinitis of peroneus longus and brevis muscles,or fracture displacement,hardware failure and malunion,and all of them had some degree of subtalar stiffness.Compared to preoperative,calcaneus width was significantly reduced immediately and 6 months after surgery,Böhler’s angle and Gissane’s angle were improved,the differences were statistically significant(all P<0.05),and compared to the opposite side,there were no statistical significance in the outcomes of calcaneal width,Böhler’s angle and Gissane’s angle(P>0.05);compared to immediately after surgery,calcaneal width,Böhler’s angle and Gissane’s angle kept normal 6 months after surgery,there were no statistical significance(P>0.05).The AOFAS score in the 6 months follow-up after surgery that was significantly improved than that of pre-operation.Conclusion The method of calcaneal fracture reduction with pushing screw is an effective method for the assisted reduction of medial wall in intra-articular calcaneal fracture,which has a variety of advantages such as simple manipulate,shorter operation ti

关 键 词：跟骨 骨折 骨折内固定术 内侧壁复位 推挤螺钉 

分 类 号：R681[医药卫生—骨科学]