全螺纹松质骨螺钉治疗跟骨骨折疗效观察

Fully threaded cancellous bone screws calcaneal fractures observed

目的探讨采用克氏针撬拨复位，微创小切口钢板全螺纹松质骨钉内固定治疗跟骨关节内骨折的临床疗效。方法2009年9月开始采用微创钢板螺栓加压内固定系统治疗跟骨关节内骨折，在实践中不断探索改进，于2011年2月开始将部分病例采用全螺纹松质骨螺钉替代加压螺栓固定，取得良好临床效果。此组病人40例；男21例，女19例；年龄21-65岁，平均41岁；左足16例，右足24例；均为闭合性跟骨关节内移位骨折，致伤原因：高处坠落伤29例，车祸伤11例；合并脊柱骨折2例，骨盆骨折1例，同侧股骨骨折2例。骨折按Sanders分型：Ⅱ型12例，Ⅲ型24例，Ⅳ型4例。所有患者术前行X线检查和CT扫描三维重建，以了解跟骨压缩的程度和关节面的完整性。结果所有患者术后均获得3～16月（平均12月）随访。切口均甲级愈合。Boehler角、Gissane角和跟骨宽度分别由术前的6．05°±3．56°、159．27°±10．62°、41．17±2．06mm恢复到术后的31．86°±2．67°、117．24°±8．47°、31．25±1．78mm，3个月后为32．61°±4．56°、119．59°±2．11°、32．12±1．86mm。骨折完全愈合，无一例发生切口皮缘坏死和感染、腓骨长短肌肌腱腱鞘炎，未出现骨折移位或内固定失败等情况。美国骨科足踝外科学会（American Orthopaedic Foot ＆ Ankle Society, AOFAS）评分系统的踝．后足评分为术前20．73±11．92分、术后3天71.38±9．47分、术后3个月72．76±17．62分。结论全螺纹松质骨螺钉替代自断型加压螺栓进行固定，可有效恢复跟骨的宽度，避免了内侧神经血管的损伤，易于取出，并发症少，临床效果满意。

Objective To explore the use of Kirschner wire poking reduction and clinical efficacy of minimally invasivesmall incision steel threaded cancellous bone screw fixation for the treatment ofintra-articular calcaneal fracture, Method In Sep. 2009 with bolt pressure of minimally invasive plate fixation system and intra-articular calcaneal fractures continueto explore ways to improve in practice, some cases in Feb. 2011 full threaded cancellous screws instead ofbolted pressure,achieved good clinical effect. 40 cases of this group of patients; 21 males and 19 females; aged 21 to 65 years （average of 41 years）; left foot 16 cases, 24 cases of right foot; closed intra-articular calcaneal fractures, the causes of injury： height 29 cases of fall injury and traffic accident in 11 cases; combined spinal fractures 2 cases of pelvic fracture patients, the ipsilateral femoral fracture in two cases. Fracture the Sanders classification： type II 12 cases, 24 cases III, IV 4 cases. All patients underwent preoperative X-ray examination and CT scan three-dimensional reconstruction, in order to understand the extent and integrity of the articular surface of the calcaneus compression. Results All the patients were 3 to 16 months （mean 12 months）. Incisions were healing. Boehler angle, Gissane angle, and calcaneal width from the preoperative 6.05°±3.56°, 159.27°±10.62°, 41.17±2.06mm to return to after surgery31.86°±2.67°, 117.24°±8.47°, 31.25±1.78mm, after 3months32.61°±4.56°, 119.59°±2.11°, 32.12±1.86mm. Fractures healedcompletely, and no case of skin flap necrosis and infection, peroneal tendons, tenosynovitis, and the fracture displacement or internal fixation failure. AOFAS scoring system of the ankle-foot score 20.73±11.92, after 3 days 71.38±9.47 in the preoperative, postoperative 3 months 72.76±17.62 points. Conclusion Threaded cancellous bone screw instead of the fixed off pressurized bolt, which can effectively restore the width of the calcaneus to avoid the medial neurovascular damage, easy to remove, fewer complications, satisfactory clinical results.