牵开器辅助下闭合复位空心螺钉内固定治疗跟骨骨折

Closed reduction and percutaneous hollow screw fixation with prototypical retractor for the treatment of calcaneal fracture

目的:探讨运用跟骨牵开器闭合复位空心螺钉内固定治疗跟骨骨折的临床疗效。方法:自2009年1月至2011年6月,运用自行设计的跟骨牵开器闭合复位经皮空心螺钉内固定治疗跟骨骨折39例(43足),其中男33例,女6例;年龄19～61岁,平均36.7岁。根据Sanders分型:Ⅱ型19足,Ⅲ型24足。测量手术前后跟骨X线片,观察跟骨的高度、宽度、B觟lher角、Gissane角恢复情况,参照美国骨科足与踝关节协会的足踝临床评分系统(AOFAS)评定跟骨功能改善情况。结果:39例均获随访,时间6～36个月,平均(15.4±3.1)个月。术后伤口均愈合,无皮缘坏死、感染病例。术前测量:跟骨高度平均(32.45±3.51)mm,跟骨宽度平均(41.60±2.42)mm,跟骨B觟lher角平均(8.64±13.2)°,跟骨Gissan角平均(136.35±15.23)°。术后测量:跟骨高度平均(43.62±1.02)mm,跟骨宽度平均(38.02±1.28)mm,跟骨B觟lher角平均(26.87±5.32)°,跟骨Gissane角平均(120.78±5.34)°,手术前后比较差异均有统计学意义(P<0.05)。患者对功能和外观满意,AOFAS评分从术前(35.64±11.23)分提高到术后(76.18±9.87)分;优29足,良11足,可3足。结论:在牵开器辅助下闭合复位空心螺钉内固定是治疗跟骨骨折的一种良好的方法,具有手术操作简便、复位满意、固定可靠、创伤小、并发症少、功能恢复快等优点。

Objective：To evaluate efficacy of closed reduction and percutaneous hollow screw fixation with prototypical retractor in treating calcaneal fracture.Methods：From January 2009 to June 2011,39 patients（43 feet） with calcaneal fracture were treated by closed reduction and percutaneous hollow screw fixation with prototypical retractor.There were 33 males and 6 females,aged from 19 to 61 years with an average of 36.7 years.According to type of Sanders,typeⅡwere in 19 feet,type Ⅲ were in 24 feet.Preoperative and postoperative X ray were estimated,the data of height,width,Blher angle,Gissane angle of calcaneous were collected,and ankle function were estimated according to AOFAS system.Results：All patients were followed up from 6 to 36 months with an average of（15.4±3.1）months.All wounds were healed well,no skin edge necrosis and infections occurred.Before operation,the height of calcaneous was average of（32.45±3.51）mm,width was（41.60±2.42） mm,Blher angle was（8.64±13.2）° and Gissan angle was（136.35±15.23）°;while after operation,the height of calcaneous was average of（43.62±1.02） mm,width was（38.02±1.28） mm,Blher angle was（26.87±5.32）° and Gissan angle was（120.78±5.34）°,and had significanty differences between preoperative and postoperative treatment（P〈0.05）.AOFAS score was improved from preoperative（35.64±11.23） to postoperative（76.18±9.87）,and 29 cases got excellent results,11 good and 3 fair.Comclusion：Closed reduction and percutaneous hollow screw fixation auxiliary by the retractor for the treatment is a good way,which has advantages of simple operation,satisfactory reduction fixation,reliable fixation,minimally invasive,less complications and rapid recovery.