“C”型臂X光机下撬拨复位经皮跟、距骨穿针内固定治疗跟骨骨折

Percutaneous reduction through roentgenography of C-arm and fixed with multiple Steinmann’s pins to treat fracture of calcaneus

目的探讨"C"型臂X光机下撬拨复位经皮跟、距骨穿针内固定治疗跟骨骨折的疗效。方法2002年6月至2006年4月在"C"型臂透视下采用"C"型臂下撬拨复位经皮穿针固定跟、距骨治疗跟骨骨折27例,男21例,女6例;年龄21～52岁,平均36.2岁;均为闭合骨折,SandersⅡ型16例(ⅡA型2例,ⅡB型9例,ⅡC型5例),Ⅲ型7例(ⅢAB型4例,ⅢAC型2例,ⅢBC型1例),Ⅳ型4例。结果27例中18例手术顺利,达到或接近解剖复位,5例SandersⅢAB型、4例SandersⅣ型骨折由于粉碎、关节面压缩过深而未能达到复位要求,改为小切口切开钢针撬拨复位内固定治疗。术前B-hler角为17.2±5.6度,Gissane角为103.7±10.5度;术后Bohler角为25.6±4.1度,Gissane角为117.3±4.6度。24例均获随访,随访时间10～36个月,平均21.7个月。按Maryland足评分系统评价术后功能,其评分为83～100分,平均93.7分,优19例,良5例。所有获得随访患者无一例发生骨折再移位等并发症,足外形良好,能够穿正常鞋,无明显跛行。结论"C"型臂下撬拨法复位经皮跟、距骨穿针内固定适应于SandersⅡ型、SandersⅢ型和部分SanderⅣ型跟骨骨折的治疗,特别是对软组织有挫伤的跟骨骨折,可明显降低软组织损伤等并发症的发生率,是一种有效、可行的微创治疗方法。

Objective To evaluate the outcome of percutaneous reduction by leverage and axial fixation with multiple Steinmann′s pins to treat fracture of calcaneus. Methods From Jun. 2002 to Apr. 2006 ,27 patients with fracture of calcaneus were treated by percutaneous reduction by leverage and axial internal fixation with multiple Steinmann′s pins. 21 cases were males and 6 cases were females by the age from 21 to 52. All the fractures were closed. According to Sanders′ classification ,16 cases were type Ⅱfracture（ⅡA 2 cases ,ⅡB 9 cases,ⅡC 5 cases）and 7 cases were type Ⅲ fracture（ⅢAB 4 cases,ⅢAC 2 cases,ⅢBC 1 case） and 4 cases were type Ⅳ fracture. Results All the patients were treated percutaneous reduction and obtained good result except 9 patients who needed another small incision to help reduction and bone graft .The preoperative X-ray film showed that the Bhler angle was （17.2±5.6）°,Gissane angle was （103.7±10.5）°. The postoperative X-ray film demonst-rated that Bhler angle was （25.6±4.1）°,Gissane angle was （117.3±4.6）°.Following-up of 24 patients was 21.7 months （range 10～36m）. All fractures healed 4 months after operation. According to Maryland foot score system,19 cases were excellent and 5 cases were good. And there was no soft tissue complications and fracture redisplacement occurred. The shape of the foot was good and the patient walked normally with no pain and claudication. Conclusion Percutaneous reduction by roentgenography of C-arm with multiple Steinmann′s pins is an effective and micro-invasive method in treatment of Sanders′typeⅡ,typeⅢ ,typeⅣ fractures of calcaneus. The technique can obtain good reduction and stable fixation with lowoperation complication.