跗骨窦切口配合反向牵引器微创复位中西医结合治疗跟骨骨折

Treatment of Displaced Intra-articular Calcaneal Fractures by Minimally Invasive Retractor Reduction and Fixation Through Sinus Tarsi Approach Together with External Application of Chinese Medicine

【目的】探讨跗骨窦切口配合反向牵引器微创复位小钢板内固定并结合中药外洗治疗跟骨关节面移位骨折的疗效。【方法】自2009年10月至2013年6月,对48例（52足）跟骨关节内骨折（Sander’sⅡ~Ⅲ型）患者行跟骨外侧跗骨窦切口配合反向牵引微创复位,术中使用小钢板内固定,术后使用中药神行方（伸筋草、透骨草、三棱、莪术、细辛、制川乌、制草乌等）外洗治疗,随访观察跟骨关节内骨折（Sander’sⅡ~Ⅲ型）的疗效情况。【结果】40例患者（44足）骨折术后获12~18个月随访（平均14.2个月）。按Maryland足部评分,Sander’sⅡ型骨折平均95分,Sander’sⅢ型骨折平均86分。术后B觟hler和Gissane角及跟骨高度、宽度、长度等恢复满意（P〈0.01）。【结论】外侧跗骨窦切口配合反向牵引器微创复位、小钢板内固定、中药神行方外洗治疗跟骨关节内骨折可获得满意的临床疗效。

Objective To evaluate the therapeutic effect of minimally invasive retractor reduction and fixation through sinus tarsi approach together with external application of Chinese medicine for displaced intra-articular calcaneal fractures. Methods From October of 2009 to June of 2013, 52 patients with displaced intra-articular calcaneal fractures（Sanders type Ⅱ, Ⅲ） were enrolled into the study. The patients received minimally invasive retractor reduction through sinus tarsi approach and fixation with small plate and cannulated screws, and after the operation were given external washing with Chinese herbal formula Shenxing Fang（ mainly composed of Herba Lycopodii, Herba Speranskiae Tuberculatae, Rhizoma Sparganii, Rhizoma Curcumae, Herba Asari,Radix Aconiti Preparata, Radix Aconiti Kusnezoffii Preparat）. Follow-up was carried out for the evaluation of the therapeutic effect of displaced intra-articular calcaneal fractures（ Sanders type Ⅱ, Ⅲ）. Results Forty cases（involving 44 feet） received the postoperative follow-up for 12-18 months（average being 14.2 months）.The Maryland foot scores were 95 points for type Ⅱ displaced intra-articular calcaneal fractures, and 86 points for type Ⅲ fractures. Satisfactory results were achieved in the height, width and length of the calcaneus as well as the Bohler＇s and Gissane angle（ P〈0.01）. Conclusion Minimally invasive retracter reduction and fixation through sinus tarsi approach together with external application of Chinese medicine exert satisfying effect for the treatment of displaced intra-articular calcaneal fractures.