跟骨载距突螺钉导向器基础与临床上的准确性评价

The accuracy of evaluation in the foundation and clinical application of the self-manufactured guider of the calcaneous sustentaculum tali screw for the fixation of the calcaneous sustentaculum tali

目的探讨自行研制的跟骨载距突螺钉导向器在尸体标本与临床上辅助固定跟骨载距突的准确性。方法 (1)采用30例成人新鲜及防腐足部标本为研究对象,用2.5 mm克氏针沿跟骨载距突螺钉导向器植入载距突内,每具标本打入1枚克氏针,观察克氏针打入载距突情况;(2)在临床上收集跟骨骨折25例(28足),根据Sanders等分型,II型9例,Ⅲ型11例,IV型8例,采用该载距突螺钉辅助治疗跟骨骨折,通过X线检查螺钉打入载距突情况。结果 (1)所有标本均置入1枚固定载距突的克氏针,其中1枚穿过载距突前下,其余29枚均从载距突的中间通过,精确率达96.7%。(2)临床病例X线片显示共置入28枚固定载距突的螺钉,其中1枚穿过载距突前方,其余27枚均从载距突的中间通过,精确率达96.4%。结论采用该导向器辅助固定跟骨的载距突,明显提高螺钉或克氏针植入载距突的准确性,在临床病例上,避免载距突螺钉位置偏差导致人为医源性并发症的发生,使用方便,适合临床推广应用。

Objective To discuss the accuracy of the self-manufactured guider of the calcaneous sustentaculum tali screw for the fixation of the calcaneous sustentaculum tali in the calcaneous specimens and the clinical. Methods （1） 15 pairs of calcaneous specimens were collected for this study. A 2.5 mm Kirschner-wire was drilled into each of the cadaveric feet according to the guider and the position of the Kirschner-wire. （2） 25 cases （28 feet） of calcaneal fracture were enrolled in this study. According to Sanders classification, there were 9 cases falling into type-II,11 cases type-III and 8 cases type-IV. The guider of the calcaneous sustentaculum tali screw was used in each case and the sustentaculum tali screw position was evaluated by X-ray postoperatively. Results （1） In the specimens, all of the 30 Kirschner-wires were implanted into the calcaneous sustentaculum tali and 29 Kirschner-wires were passed though the middle of the sustentaculum tali;However, 1 Kirschner-wire was passed through the anteroinferior part of the sustentaculum tali. The accurate rate by this guider was 96.7%. （2） A total of 28 sustentaculum tali screws were implanted in 25 patients, and 27 screws were passed thoughthe middle of the sustentaculum tali. However, 1 screw was passed through the anterior part of the sustentaculum tali. The accuracy rate was 96.4%. Conclusion The self-manufactured guider of the calcaneous sustentaculum tali screw can significantly improve the accuracy of the screw or Kirschner-wire being implanted into the sustentaculum tali, which can avoid the artificial iatrogenic complications caused by the position deviation of the sustentaculum tali screw. Therefore, it is appropriate to be promoted widely in clinical practice.