“Z”形跟腱切断经皮穿针撬拨复位术治疗关节内跟骨骨折

Treatment to Displaced Intra-articular Calcaneal Fracture by Z-shaped Achilles Tendotomy and Percutaneous Steinmann Reduction

目的：探讨一种简单、实用、有效的治疗关节内跟骨骨折的方法．方法：“Z”形跟键切断，经皮纵向钻入φ（3．5～4）mm骨圆针至跟骨后关节面下方撬拨，跟骨钳钳夹跟骨内外侧壁，进行挤压，经X线透视及卡尺测定证实复位满意后，该针继续钻入，穿过跟骰关节直至骰骨，石膏外固定6周．比较双侧跟骨Boehler角及跟骨宽度，评估骨折复位情况，并测定踝关节功能，随访多项临床指标，评价临床疗效、结果：24例关节跟骨骨折行本法治疗，随访8～68个月（平均27个月），临床疗效优15例、良6例、一般2例、差l例、本组疗效优良率为87．5％．结论：跟腱切断有利于关节内跟骨骨折的复位．跟腱“Z”形切断石膏固定6周后，跟腱功能可逐步恢复，踝关节功能无明显影响．

Objective： To establish a simple, practical and effective procedure for the treatment of displaced intra-articular calcaneal fracture. Methods： The reduction procedure began with Z-shaped achilles tendotomy, then percutaneous axial insertion of Steinmann pin and bilateral compression with calcaneal clamp. After reduction, the calcaneus were checked by X-ray photography and yardstick instantly. Then the pin was penetrated to the cuboides, external cast fixation together with the pin insitu was lasted 6 weeks. The reduction criteria were the restorations of calcaneal Boehler angle and of the calcaneal width. The function of the ankle and a series of clinical parameters were evaluated in follow up studies. Results： 24 patients with displaced intra-articuiar fracture ofcalcaneus were managed by the procedure and followed up to a mean 27.1 months （8 - 68 months）. The convalescence was evaluated as excellent in 15 patients, good in 6, fair in 2 and poor in 1 of 24 patients. The clinical results were satisfied in 87.5% patients. Conclusion： Achilles tendotomy facilitates the reduction of intra-articular calcaneal fracture. The function of achilles tendon can reestablish convalescence gradually after tendotomy and cast fixation. There was no significant influence in the function of the ankle.