闭合撬拨复位经皮空心螺钉内固定治疗跟骨舌形骨折

Treatment of linguiform calcaneus fracture by close nail pry reduction and internal fixation with hollow screws

目的:探讨闭合撬拨复位经皮空心螺钉内固定治疗跟骨舌形骨折的手术疗效。方法:自2006年5月至2009年10月共收治32例(35足)跟骨舌形骨折,男23例,女9例;年龄25～46岁,平均37.6岁。根据Paley分类法:PaleyⅡa型3例,PaleyⅡb型29例,均为闭合性骨折。手术时间为伤后3～10d,均等局部肿胀消退至中、轻度后手术。通过X线片测量手术前后B觟hler角及Gissane角,并按张铁良足部综合评分法进行评定。结果:32例均获随访,时间6～18个月,平均12个月。骨折全部愈合,平均愈合时间12个月,无一例感染。术后B觟hler角及Gissane角比术前改善,按张铁良足部综合评分法进行评定,优18足,良10足,可5足,差2足。结论:闭合撬拨复位经皮空心螺钉内固定治疗跟骨舌形骨折充分恢复了患者的功能,具有创伤小、费用低、无明显后遗症等优点。

Objective： To study the curative effects of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture. Methods：From May 2006 to October 2009,32 patients （35 feet） with linguiform calcaneus fracture were treated by close nail-pry reduction and internal fixation with hollow screws,including 23 males and 9 females ranging in age from 25 to 46 years, with a mean of 37.6 years. According to Paley classification, 3 cases were Paley Ⅱ a, and 29 cases were Paley Ⅱ b. All cases were close fractures. The time from injury to operation was 3 to 10 days after most swelling subsided. Btihler angle and Gissane angle were measured by X-ray before and after operation. The therapeutic effect was assessed according to ZHA NG Tie-liang＇s foot score. Results：All the patients were followed-up for 6 to 18 months, with a mean of 12 months. All fractures gained bone healing. The time of fracture healing averaged 12 months. The fractures healed completely and no infection occurred. According to ZHANG Tie-liang＇s foot scale, the postoperative function was excellent in 18 feet,good in 10 feet,moderate in 5 feet and poor in 2 feet. The Bohler angle and Gissane angle were significant improved af- ter treatment （P〈0.01）. Conclusion ：The surgical method of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform ealcaneus fracture can regain the foot function, with minimal injury, fewer complications, earlier recov- ery and lower costs.