经跗骨窦入路跟骨锁定钢板外固定治疗跟骨关节内骨折

Treatment of intra articular calcaneal fractures by minimally invasive through the sinus tarsi approach and external fixation with calcaneal locking plates

目的:探讨经跗骨窦入路、跟骨锁定钢板外固定治疗跟骨关节内骨折临床疗效。方法:自2011年7月至2012年8月,采用经跗骨窦入路小切口切开复位、跟骨锁定钢板置于皮外固定治疗跟骨关节内骨折12例(13足),其中男10例,女2例;年龄25～48岁,平均35岁。骨折根据Sanders分型:Ⅱ型7足,Ⅲ型6足。比较手术前后跟骨B觟hler角、Gissane角,并按照Maryland足部评分系统对疗效进行评价。结果:12例均获得随访,时间6～14个月,平均10个月。术后无切口皮肤并发症;骨折愈合时间3～6个月,平均4个月。B觟hler角由术前(11.19±5.69)°提高至术后(30.13±7.52)°;Gissane角由术前(108.31±10.35)°提高至术后(118.99±8.94)°。按照Maryland足部评分系统:优8足,良3足,可2足。结论:经跗骨窦入路、跟骨锁定钢板外固定治疗跟骨关节内骨折,复位效果确切,固定牢固,可早期手术,手术损伤小,并发症少,是治疗SandersⅡ、Ⅲ型跟骨关节内骨折的一种有效方法。

Objective ： To investigate the clinical results and the superiority of minimally invasive sinus tarsi approach and external fixation with calcaneal locking plates for the treatment of the intra-articular calcaneal fracture. Methods：From July 2011 to August 2012,12 cases （13 feet） were treated by sinus tarsi approach and external fixation with calcaneal locking plates. There were 10 males and 2 females ,aged from 25 to 48 years old （means 35 years old）. According to Sanders classification system,there were 7 feet with type 11 ,6 feet with type m The Bshler angle and Gissane angle were compared before and after operation. The clinical results were evaluated with the Maryland foot score system. Results：All 12 cases were fol- lowed up from 6 to 14 months （means 10 months）. There were no incision complications. Fracture healing time was from 3 to 6 months （means 4 months）. The Bohler angle increased from preoperative （11.19±5.69）° to postoperative （30.13±7.52）°; The Gissane angle increased from preoperative （108.31±10.35）° to postoperative （118.99±8.94）°. According to Maryland foot score system, 8 feet got an excellent result, 3 good, 2 fair. Conclusion：Open reduction by sinus tarsi approach and external fixation with calcaneal locking plates is an effective method for treatment of Sanders II , III calcaneal fracture. It can obtain good reduction and stable fixation with minimal invasion and lower complications.