跟骨骨折的可调式三角形外支架的研制和临床应用

Design and application of adjustable triangle external fixator for the treatment of calcaneal fractures

目的:设计用于跟骨骨折的可调式三角形外支架,并研究其临床应用效果。方法:支架安装在3根横穿跟骨结节、胫骨下端、第1楔骨的克氏针的肢体两侧,通过调节支架的支撑杆长度使克氏针作用于跟骨结节,使跟骨的B觟hler角和其前后径得到恢复,辅以手法复位,达到恢复跟骨形状的目的。自2003年4月至2008年4月临床治疗34例,男30例,女4例;年龄19～54岁,平均36.7岁;B觟hler角-5°～15°,平均13.5°。其中SanderⅡ型2例,Ⅲ型20例,Ⅳ型12例。结果:34例均得到随访,时间3个月～4年,平均25个月。B觟hler角恢复至30°～40°,平均32.5°。Maryland评分由术前平均(24.76±15.05)分提高至术后平均(83.26±16.81)分,按Maryland标准评定,优8例,良21例,可3例,差2例。结论:用于跟骨骨折的可调式三角形外支架具有方法简便、复位好、再损伤小、并发症少的优点,纠正B觟hler角和恢复跟骨前后径效果确实,是治疗跟骨骨折早期较为理想的方法。

Objective：To design a kind of adjustable triangle external fixator,and to use it for treating calcaneal fractures.Methods：The external fixator was installed into extremity near the both sides of three Kirschner wires crossing the calcaneal tubercle,the lower end of the tibia and the first cuneiform.The support rod length was adjusted to ensure the Kirschner wires affecting the calcaneal tubercle,so the Bhler angle and anteroposterior diameter of the calcaneus were recovered.From April in 2003 to April in 2008,the external fixators were used to treat 34 patients with calcaneal fractures,including 30 males and 4 females,ranging in age from 19 to 54 years,with an average of 36.7 years.The Bhler angles were-5 degree to 15 degree,with an average of 13.5 degrees.According to Sander＇s classification,2 patients were type Ⅱ,20 patients were type Ⅲ,and 12 patients were type Ⅳ.Results：Thirty four patients were followed up,and the duration ranged from 3 months to 4 years,averaged 25 months.The Bohler angle recovered to 30 degree to 40 degrees,with a mean of 32.5 degrees.The Maryland mean score improved from preoperative （24.76±15.05） to postoperative （83.26± 16.81）.Based on Maryland criteria,8 patients got an excellent result,21 good,3 fair and 2 bad.Conclusion：The adjustable triangle external fixator for treating calcaneal fractures has the following advantages：simple approach,good recovery,little reinjury and complications,effectiveness to recovery Bohler angle and anteroposterior diameter of calcaneal,which is an ideal method to treat calcaneal fractures.