可注射型人工骨联合撬拨复位穿针治疗跟骨骨折的初步报告

The preliminary report of injectale bone graft combined with percutaneous reduction by leverage and fixation of Steinmann's pin for the treatment of calcaneal fracture

目的探讨可注射型人工骨联合撬拨复位穿针固定治疗跟骨骨折的疗效。方法2005年7月～2006年11月收治单侧跟骨骨折患者8例,运用微创小切口植骨联合经皮撬拨复位穿针固定治疗,男5例,女3例;年龄21～60岁,平均年龄42岁;高处坠落伤4例,车祸伤2例,其它2例;8例患侧X线测量Bohler角,-1°～10°,平均2°。Gissane角82°～100°,平均92.36°;SandersⅡ型6例(ⅡA3例,ⅡB3例),Ⅲ型2例(ⅢAB1例,ⅢAC1例)。结果所有8例获得完整随访,随访时间为8～15月,平均12.3月。术后并发症发生率为12.5%(1/8)。Bohler角改善大于18～25°,Gissane角改善大于30～35°。按照AOFAS踝与后足功能评分系统评价术后患足功能,本组优(90～100分)6例,良(75～89分)2例,均获得骨性愈合。所有8例术后均未发生皮肤坏死,血肿,深部感染等并发症。结论采用可注射型人工骨联合撬拨复位穿针固定治疗跟骨关节内骨折,足部功能恢复满意,并且并发症少。

Objective To discuss the effects of injectale bone graft combined with percutaneous reduction by leverage and fixation of Steinmarm ＇ s pin for the treatment ofcalcaneal fracture. Methods 8 patients with unilateral intra-articular calcaneal fracture were treated with the method of mini-incision combined with percutaneous reduction by leverage and axial fixation of Steinmann＇ s pin from June 2005 to November 2006.5 cases were males and 3 were females. The average was 42 years （range, 21-60 years）. The mechanism of injury was fall in 4 cases, vehicle accident in 2 cases and other in 2 cases. The preoperative x-ray showed Bohler angle was - 1°to 10° （mean 2°）, Gissane angle was 82°to 100° （ mean 92.36°）. According to Sanders classification, 6 cases were typeⅡ fractures （3 type Ⅱ A, 3 type Ⅱ B ）, 2 cases were type Ⅲ fractures （1 type ⅢAB, 1 type ⅢAC）. Results All cases were followed up from 8 to 15 months （mean 12.3 months）. The complication rate reached 12.5% （1/8）. The improvement of Bohler angle exceeded 18° to 25°and that of Gissane angle exceeded 30°to 35°. According to the ankle-hindfoot score of American Orthopedic Foot and Ankle Society （AOFAS）, 6 cases were excellent and 2 cases were good. All reached bone union. None of all had complication of necrosis of skin, hematoma and deep infection. Conclusions Injectale bone gratt combined with percutaneous reduction by leverage and fixation of Steinmann＇ s pin for the treatment of calcaneal fracture can lead to satisfactory functional restoration and few complications.