“辨型论治”微创内固定术治疗跟骨骨折

Treatment of Calcaneal Fractures with Minimally-invasive Internal Fixation Based on Sanders Classification

【目的】探讨“辨型论治”治疗跟骨骨折的微创内固定术式，并观察其疗效。【方法】选取63例（67侧）跟骨骨折病例，根据分型选取闭合复位经皮钢板／螺钉内固定进行治疗。【结果】共59例患者获得9—18个月的随访，术后跟骨Boelher角和Gissane角大部分恢复良好。除经皮铜板治疗中SandersⅣ型的Gissane角外．其余各型与术前比较差异均有统计学意义（P〈0．05）。根据Creighton—Nebraska跟骨骨折评分标准，铜板与螺钉病例术后功能评分优良率分别为81．82％和82．76％，差异无统计学意义（P〉0．05）。【结论】“辨型论治”治疗跟骨骨折结果满意，疗效确切。推广价值较高。

Objective To introduce the techniques of percutanceous minimally-invasive plate/hollow screw osteosynthesis for the treatment of calcaneal fractures and to evaluate their clinical effects. Methods Sixty-three （involving 67 feet） calcaneal fracture patients were treated by closed reduction and percutanceous minimally-invasive fixation with plate or hollow screw based on the results of Sanders classification. Results Fifty-nine calcaneal fracture patients were followed up for 9 to 18 months after treatment. The Boelher angle and Gissane angle of the caleaneus recovered well in most of the postoperative patients, and the differences were significant （P〈0.05 compared with those before operation） except the Gissane angle of Sanders IV calcaneal fracture patients treated with percutanceous minimally-invasive plate osteosynthesis. The results of Creighton- Nebraska scoring showed that excellent and good rate was 81.82% for minimally-invasive plate osteosynthesis and was 82.76% for minimally-invasive hollow screw osteosynthesis, the difference being insignificant （P〉 0.05）. Conclusion Minimally-invasive internal fixation based on Sanders classification shows certain therapeutic effect for calcaneal fractures.