经跗骨窦小切口微型锁定接骨板组合经皮螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折

Fixation with a mini-locking plate and percutaneous screws via mini-open sinus tarsi approach for calcaneal fractures of Sanders types Ⅱ and Ⅲ

目的探讨经跗骨窦小切口复位后距下关节面，微型锁定接骨板组合经皮螺钉内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的方法及疗效。方法2011年2月至2012年2月收治19例闭合性跟骨骨折患者，男12例，女7例；年龄20～62岁，平均37．4岁；骨折按Sanders分型：Ⅱ型14例，Ⅲ型5例。均采用经跗骨窦小切口复位后距下关节面，以2．4mm足舟状骨锁定接骨板组合经皮螺钉内固定进行治疗，术后观察切口愈合及并发症发生情况，通过复查x线及CT评价骨折复位情况，并应用美国足踝外科协会（AOFAS）踝-后足评分标准评定疗效。结果17例患者术后获12～24个月（平均16．2个月）随访。1例患者术后出现切口延迟愈合（Sanders Ⅲ型），经局部换药后治愈。末次随访时未发现内固定物松动、断裂，骨折愈合时间8～12周（平均10.7周），无畸形愈合发生。Bohler角由术前6．4°±5．5°改善为末次随访时24．9°±4．1°，Gissane角由术前96．1°±5．4°改善为末次随访时110．7°±8．4°，差异均有统计学意义（P〈0．05）。AOFAS踝-后足评分：优8例，良6例，可3例。至末次随访时本组患者尚未观察创伤性关节炎征象。结论采用经跗骨窦小切口直视下复位后距下关节面，微型锁定接骨板组合经皮螺钉内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折，术中不仅可以获得满意复位，而且可以有效维持骨折复位，同时减少切口并发症的发生。

Objective To evaluate the fixatior, with a mini-locking plate and pereutaneous screws via the mini-open sinus tarsi approach for ealeaneal fractures of Sanders types Ⅱ and Ⅲ. Methods Nineteen patients with closed caleaneal fracture were treated hetween Fehruary 2010 and February 2012. They were 12 men and 7 women, with an average age of 37.4 years （from 20 to 62 years） . According to the Sanders classification, 14 cases were type Ⅱ and 5 type Ⅲ. All cases were treated with internal fixation with a 2.4 mm mini-locking plate and percutaneous screws via the mini-open sinus taxi approach following reduction of the posterior articular surface of the subtalar joint. Postoperatively, wound healing and complications were observed, and X-ray fihns and CT scans were evaluated carefully to determine fracture union. Functional recovery was evaluated according to the Ankle ＆ Hind-foot Score of American Orthopedic Foot and Ankle Society （AOFAS） . Results Seventeen patients were followed up for a mean duration of 16.2 months （ 12 to 24 months）. Of them, one of Sanders type III experienc, ed delayed wound healing which was cured by local dressing change. No complication of wound infection or hardware failure was noted. Bone union was achieved at an average of 10. 7 weeks （8 to 12 weeks）. No obvious malunion occurred by the last follow-up. The Bohler angle increased significantly from 6.4° ± 5.5° preoperatively to 24.9° ± 4. 1° at the last follow-up while the Gissane angle significantly from 96. 1° ± 5.4° preoperatively to 110.7°± 8.4° at the last follow-up （ P 〈 0.05）. By the AOFAS scoring, 8 cases were rated as excellent, 6 as good and 3 as fair. Conclusions Fixation with a mini-locking plate and pereutaneous screws via the mini-upen sinus tarsi approach is an effective treatment for calcaneal fractures of Sanders types Ⅱ and Ⅲ, because it may lead to satisfactory reduction and stable fixation, and limit soft tissue complications as well.