撬拨复位克氏针内固定治疗Sanders Ⅱ型跟骨舌形骨折

Percutaneous reduction by leverage and kirschner wire fixation in patients with Sanders type Ⅱ linguiform fractures of calcaneus

目的：探讨采用闭合撬拨复位，克氏针内固定治疗SandersⅡ型跟骨舌形骨折的方法和疗效。方珐：在术中透视及CT监测下，采用闭合撬拨复位，克氏针内固定治疗SandersⅡ型跟骨舌形骨折22例，复位后经术中影像学检查，要求后跟距关节面解剖复位，恢复跟骨的长度、宽度、高度和Bhler角、Gissane角，克氏针内固定结合石膏外固定。术后6周去除石膏，8周拔除克氏针，逐步负重。术后6月内每月进行随访1次。结果：22例均获得随访，时间18～24月，平均16．8月。骨折全部愈合，术前Bhler角平均8．1度，术后平均35．4度；术前Gissane角平均108．4度，术后平均114．5度。术后1年的AOFAS评分平均83．5分。结论：采用闭合撬拨复位，克氏针内固定的方法治疗SandersⅡ型跟骨舌形骨折，能有效保证跟距关节后关节面的解剖复位，恢复跟骨的解剖形态，手术损伤小，术后外观、功能恢炭满意。

Objective： To observe the effects of percutaneous reduction by leverage and Kirschner wire internal fixation in patients with Sanders Type Ⅱ linguiform fractures of calcaneus. Methods： Twenty two cases with Sanders Type Ⅱ linguiform fractures of the calcaneus were treated with percutaneous reduction by leverage and Kirschner wire internal fixation under monitoring of image intensifier or CT scan. Plaster external fixation was needed post operatively. Post reposition, Imaging tested anatomic reduction of posterior facet, restoration of length, width, height, and angle B hler and Gissane. Plaster was removed 6 weeks post operation, Kirschner wire was pulled out 8 weeks post operation, and then weight bearing was carried on progressively. Following up was taken on every month in 6 months. Results： All 22 cases were followed up 18 to 24 months, mean 16.8 months. Fracture healing was occurred in all cases. The mean of angle B hler was 8. 1 degree pre operation and 35. 6 degree post operation. The mean of angle Gissane was 108.4 degree pre operation and 114.5 degree post operation. The mean score of AOFAS of 1 year was 83.5. Conclusion, Percutaneous reduction by leverage and Kirschner wire internal fixation is effective on anatomic reduction of posterior facet of the joints of calcaneal bone and ankle-bone and restoration of calcanean anatomic form in patients with Sanders Type Ⅱ linguiform fractures of calcaneus. The ad-vantages of this management have minimal injury, satisfactory external appearance and functional recovery.