撬拨复位空心螺钉内固定治疗跟骨Essex-LoprestiⅡ型骨折

Poking reduction and cannulated screw fixation for the treatment of calcaneal fractures of Essex-Lopresti type Ⅱ

目的探讨撬拨复位空心螺钉内固定治疗跟骨Essex-LoprestiⅡ型骨折的近期疗效。方法手术治疗41例跟骨Essex-LoprestiⅡ型患者,21例行撬拨复位空心螺钉内固定术（A组）,20例行撬拨复位斯氏针内固定管型石膏外固定术（B组）。记录两组手术时间及术中出血量;比较术前、术后跟骨Bhler角及Gissane角的变化,评估跟骨复位情况;采用Maryland足部评分系统评估疗效。结果患者均获得随访,时间12-18个月。两组手术时间、术中出血量、手术前后Bhler角、Gissane角的变化比较差异均无统计学意义（P〉0.05）。两组术后Bhler角、Gissane角与术前比较差异均有统计学意义（P〈0.05）。患足功能：A组优11例,良9例,可1例,优良率20/21;B组优2例,良11例,可7例,优良率13/20;两组优良率比较差异有统计学意义（P〈0.05）。所有患者术后无皮肤坏死,无切口及针道感染。结论采用撬拨复位空心螺钉内固定治疗跟骨Essex-LoprestiⅡ型骨折,近期可获得良好的复位和可靠的疗效。

Objective To explore the short-term efficacy of poking reduction and cannulated screw fixation for the treatment of calcaneal fractures of Essex-Lopresti type Ⅱ. Methods 41 patients of Essex-Lopresti type Ⅱ calcaneous fracture were treated with operation. 21 cases of poking reduction and cannulated screw fixation（ group A）,20 cases of poking reduction Steinmann＇s pin tubular gypsum external fixation（ group B） were enrolled. The operation time and bleeding volume during operation were recorded. Calcaneal reduction was assessed in order to compare the change of calcaneus Bhler angle and Gissane angle. Maryland foot score system was used for assessment. Results All patients were followed up from 12 months to 18 months. The operation time and bleeding volume during operation,the change of Bhler angle and Gissane angle in the two groups had no significant difference（ P〈0. 05）. There was significant difference in the two groups of patients before and after surgery on changes of Bhler angle and Gissane angle（ P〈0. 05）. There were 11 excellent cases in the group A,good in 9,fair in 1,excellent-good rate was 20 /21,2 excellent cases in group B,good in 11 cases,fair in 7 cases,excellent-good rate was 13 /20. The excellent and good rate between the two groups had statistical significance（ P〈0. 05）. No skin necrosis,incision and pin tract infection in all cases after the operation. Conclusions By poking reduction and cannulated screw fixation for the treatment of calcaneal fractures of Essex-Lopresti type Ⅱ,recent therapeutic effect can be obtained reliably.