跗骨窦入路复位经皮克氏针固定治疗儿童跟骨关节内骨折的疗效观察

Clinical observation on the curative effect of tarsal sinus approach for reduction and percutaneous kirschner wire fixation on the treatment of intra-articular fracture of calcaneus in children

目的：探讨跗骨窦入路复位经皮克氏针固定治疗儿童跟骨关节内骨折的临床疗效。方法：采用跗骨窦入路经皮克氏针内固定治疗儿童跟骨关节内骨折患者9例（10足）。手术前后测量X线片B hler角、Gissane角,定期随访并采用Maryland评分系统对患足功能进行评定。结果：术后B hler角、Gissane角分别与术前比较,差异有统计学意义（t=7.830,P=0.000;t=4.912,P=0.001）。随访12~58个月,平均25.1个月,骨折均获愈合,无1例发生切口愈合不良、切缘坏死感染。Maryland评分93~100分,平均96.8分。结论：跗骨窦入路复位经皮克氏针固定具有创伤小、手术暴露充分、固定可靠、并发症少等优点,是治疗儿童跟骨关节内骨折的一种有效的微创手术方法。

Objective：To evaluate the clinical curative effect of tarsal sinus approach for reduction and percutaneous K-wire fixation on intraarticular fracture of calcaneus in children.Methods：Tarsal sinus approach for reduction and percutaneous K-wire fixation were applied in the treatment of 9 children（10 feet）with intraarticular fracture of calcaneus.Bhler angle and Gissane angle of X-ray film were measured before and after the operation.Regular follow-up was done for the patients,and the function of affected feet was evaluated according to Maryland scoring system.Results：There was statistical difference in the values of Bhler angle and Gissane angle after the operation compared with those before the operation（t=7.830,P=0.000;t=4.912,P=0.001）.All the cases were followed up and the period ranged from 12 to 58 months（averaged in 25.1 months）.All the cases showed bony union without any badly incision healing or necrosis infection of incisal margin.The Maryland scores ranged from 93 to 100 points with an average of 96.8 points.Conclusion：The method of tarsal sinus approach for reduction and percutaneous K-wire fixation has the advantages of minimal-invasion,thorough exposure of surgical field,reliable fixation and less complications,so it is an effective and minimally invasive treatment for intraarticular fracture of calcaneus in children.