跟骨外固定器的研制与临床应用

Manufacture and clinical application of a external fixator for calcaneal fractures

目的探讨自行研制的跟骨外固定器治疗跟骨关节内骨折的临床效果。方法回顾性分析2006年5月至2009年5月收治的30例跟骨关节内骨折患者的病例，男20例，女10例；年龄15～53岁，平均36岁。根据Sanders等分型，Ⅲ型16例，Ⅳ型14例。先应用自行研制的跟骨外固定器初步进行跟骨骨折的大体复位和固定，然后通过跟骨外侧小切口充分暴露并精确复位跟骨的后关节面。比较术前、术后3d及术后6个月在跟骨侧位及轴位X线片上测得的跟骨长度、宽度、丘部高度、后关节面最大垂直移位、B6hler角的变化。根据Buckley标准，通过CT扫描评估后关节面复位情况。结果所有患者均获得随访，随访时间4-45个月，平均29个月。术后3d和术后6个月时患侧跟骨侧位及轴位X线片示上述跟骨的解剖结构基本恢复至正常范围，并分别与术前比较，差异均有统计学意义；术后6个月与术后3d比较，差异无统计学意义。末次随访时CT扫描示后关节面解剖复位27例，关节面不平整≤2mm者3例。结论此跟骨外固定器治疗跟骨关节内骨折疗效确切，具有微创、实用、并发症少的特点。

Objective To evaluate the clinical results of indirect reduction and fixation with the self-manufactured external fixator as a viable alternative in the surgical treatment of intraarticular caleaneal fractures. Methods From May 2006 to May 2009, a total of 30 patients undergone surgical treatment of in- traarticular calcaneal fractures were analyzed, including 20 males and 10 females with an average age of 36 years （range, 15-53）. According to Sanders classification based on the computed tomography scan of intraar- ticular calcaneal fractures, 16 patients were classified as type-Ill, and 14 type-IV in this series. All fractures were treated first with the external forator as indirect reduction and fixation device on the whole, which can enlarge the interspace of the subtalar joint significantly. Then, posterior articular facet of calcaneus was ex- posed and reduced through a small lateral incision. The calcaneal＇s length, breadth, thalamus height, maxi- mum vertical displacement of the post-articular surface, and BShler angle were measured preoperatively, 3 days and 6 months after operation in X-ray film. Reduction results were evaluated by CT scan according to the standard of Buckley. Results The average follow-up time of all patients was 29 months （range, 4-45）. Lateral and axial roentgenograms showed satisfactory restoration of the calcaneal＇s anatomical structure. There were significant differences between preoperative values and those 3 days or 6 months postoperatively. There were no significant differences between values 3 days postoperatively and those 6 months postopera- tively. The reduction results of posterior articular facet were evaluated by CT scan. Twenty-seven patients obtained anatomical reduction, 3 patients obtained uneven articular facet within 2 mm. Conclusion This selfmanufactured external fixator is a vialbe alternative in the treatment of intraarticular calcaneal fractures, which has advantages of minimal invasion, practicality and less complications.