经皮斯氏针撬拨复位外固定架治疗粉碎性跟骨骨折

Percutaneous poking reduction by Steinmann pin and external fixator in comminuted calcaneal fractures

目的探讨经皮斯氏针撬拨复位外固定架治疗粉碎性跟骨骨折的疗效。方法采用经皮斯氏针撬拨复位外固定架治疗32例（37足）粉碎性跟骨骨折患者。结果骨折均获解剖复位。32例均获随访，时间2～12个月。Btihler角术前为-22°～26°（8、5°±12．3°），拆除外固定架后为24°～35°（28．4°±6．2°）；Gissane角术前为136°～168°（155．2°±9．4°），拆除外固定架后为108°～142°（127．6°±17．7°）；差异均有统计学意义（P〈0．05）。根据美国足踝骨科协会（AOFAS）踝-后足评分系统进行评分：优27足，良6足，可4足，优良率为89．20％。无伤口感染，斯氏针及外固定针无断裂、松动、滑脱。3例发生创伤性关节炎，经药物治疗后症状缓解。结论经皮斯氏针撬拨复位外固定架治疗粉碎性跟骨骨折能够达到解剖复位，术后并发症少，疗效确切。

Objective To evaluate the clinical effect of treatment of comminuted calcaneal fractures with percutane- ous poking reduction by Steinmann pin and external fixator. Methods A total of 32 patients with comnfinuted calca- heal fractures were treated with percutaneous poking reduction by Steinmann pin and external fixator. Results All fractures were anatomical reduced by operation. All cases were followed up for 2 - 12 months. The BOhler angle was recovered from - 22° - 26° （ 8.5° ± 12. 3° ） to 24° - 35° （ 28.4° ± 6. 2°） , the Gissane angle was recovered from 136° - 168° （ 155.2°±9.4° ） to 108° ± 142° （ 127.6° ±17.7° ） , and there was statistically significant difference be- fore and after operation （P 〈 O. 05 ） respectively. According to American Orthopedic Foot Ankle Society （AOFAS） ankle-hindfoot scoring system, 27 feet were rated as excellent, 6 as good, 4 as fair with the excellent-good rate of 89.20%. No cases of infection, external pins and Steinmann pin crack, loosening and slip was found. 3 cases had traumatic arthritis, all cases were relieved by pharmacotherapy. Conclusions The application of percutaneous po- king reduction by Steinmann pin and external fixator to treat comminuted calcaneal fractures has advantages of effec- tive fixation, fewer complication and excellent function.