闭合复位经皮固定治疗跟骨后结节“鸟嘴样”骨折  

Closed reduction and percutaneous fixation for“Beak”fracture of the calcaneal posterior process

作　　者：李天予 汪建 任胜全 王琛涵 董全宇 Li Tianyu;Wang Jian;Ren Shengquan;Wang Chenhan;Dong Quanyu(Department of Hand and Foot Microsurgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong,China)

机构地区：[1]青岛大学附属医院手足显微外科,山东青岛266000

出　　处：《足踝外科电子杂志》2024年第4期18-23,共6页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的本研究中对跟骨后结节的“鸟嘴样”骨折进行了闭合复位经皮内固定术,并对其疗效进行评估。方法2012年3月至2017年9月青岛大学附属医院对17例跟骨后结节“鸟嘴样”骨折的患者进行闭合复位经皮内固定术,患者平均随访为17.2个月,检查术前跟骨后侧皮肤的情况,将其分为3组:无变化组、发紫组及坏死组。跟骨骨折后缘分离的距离,是否累及后关节面,骨折块的形态,骨折块的后缘与骨折线是锐角还是钝角均在术前X线片上进行评估,分为锐角组和钝角组。最后一次随访时行负重位X线片检查,评估美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分及视觉模拟评分法(visual analogue scale,VAS)评分,观察术后并发症及患者恢复到损伤前活动水平的时间。结果平均年龄为47.1(30~67)岁,平均伤后至手术时间为4.2(1~8)d。跟骨后侧皮肤条件为正常组7例(41.2%),发紫组7例(41.2%),坏死组3例(17.6%)。术前所有发紫组的患者术后皮肤均恢复正常,但3例全层皮肤坏死的患者,1例皮肤未行手术干预,在6个月后愈合,另外2例另行皮瓣手术覆盖坏死皮肤。术前骨块后缘间最大距离为23.82(9~39)mm。跟骨后缘骨块形态钝角组10例,锐角组7例。平均手术时长为47.6(30~120)min。平均AOFAS评分为92.6(80~100)分,平均VAS评分为1.9(1~6)分。无骨折不愈合、畸形愈合及内固定物失效的患者。所有患者平均回到伤前职业或日常活动水平的时间为5.2(4~8)个月。结论闭合复位经皮内固定治疗跟骨后结节“鸟嘴样”骨折,可获得满意的临床疗效,是一种安全、有效可行的手术方式。Objective This study evaluated the efficacy of closed reduction and percutaneous internal fixation for"bird's beak"fractures of the posterior calcaneal tuberosity.Methods From March 2012 to September 2017,17 patients with"bird's beak"fractures of the posterior calcaneal tuberosity underwent closed reduction and percutaneous internal fixation at the Affiliated Hospital of Qingdao University.The patients were followed up for an average of 17.2 months.Preoperative conditions of the posterior calcaneal skin were assessed and divided into three groups:no change group,purple group,and necrosis group.The distance of posterior calcaneal fracture separation,involvement of the posterior articular surface,fracture block morphology,and whether the posterior edge of the fracture block formed an acute or obtuse angle with the fracture line were evaluated on preoperative X-ray films,and patients were divided into acute angle group and obtuse angle group.At the last follow-up,weight-bearing X-ray films were taken to assess the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot functional score and visual analogue scale(VAS)score,and postoperative complications and the time for patients to recover to their pre-injury activity levels were observed.Results The average age was 47.1(30~67)years,and the average time from injury to surgery was 4.2(1~8)days.The condition of the posterior calcaneal skin was normal in 7 cases(41.2%),purple in 7 cases(41.2%),and necrosis in 3 cases(17.6%).All patients in the purple group had normal skin after surgery,but 3 patients with full-thickness skin necrosis,1 of whom did not undergo surgical intervention,healed after 6 months,while the other 2 underwent skin flap surgery to cover the necrotic skin.The maximum distance between the posterior edges of the bone blocks before surgery was 23.82(9~39)mm.There were 10 cases in the obtuse angle group and 7 cases in the acute angle group for the morphology of the posterior calcaneal bone blocks.The average operation duration was 47.6(30~120)minu

关 键 词：“鸟嘴样”骨折 跟骨 空心钉 闭合复位 经皮固定 

分 类 号：R68[医药卫生—骨科学]