距下关节撑开器在粉碎性跟骨骨折手术治疗中的应用

Application of subtalar joint distractor in operative treatment for comminuted calcaneal fracture

目的探讨术中应用距下关节撑开器辅助开放复位接骨板内固定术治疗跟骨粉碎性关节内骨折的方法及临床疗效。方法纳入2011年5月-2013年7月行切开复位内固定手术治疗的22例跟骨骨折患者，根据手术方式将患者分为两组：A组应用距下关节撑开器术中辅助复位（11例），B组术中应用斯氏针牵引及撬拨辅助复位（11例），两组患者均应用跟骨外侧接骨板固定骨折。比较两组患者手术时间、手术前后Bohler角、Gissanes角、跟骨高度、手术切口愈合及并发症变化评估手术情况。患者行内固定物取出术时，应用美国足踝外科学会（AOFAS）评分标准评估疗效。结果22例患者术后均获随访12～18个月[（14．3±0．8）个月]。B组2例出现切口延迟愈合，经换药处理获得痊愈。末次随访时，所有患者骨折均完全愈合，内固定物均顺利取出，无感染、骨折不愈合、畸形愈合或内固定失败。A组术后Bohler角、手术时间及跟骨高度均优于B组（P〈0．01）。两组术后Gissanes角差异无统计学意义（P〉0．05）。与术前比较，两组患者术后Bohler角、Gissanes角及跟骨高度均明显改善（P〈0．01）。AOFAS评分A组为（83．6±1．4）分，B组为（81．7±1．5）分。结论距下关节撑开器辅助复位跟骨粉碎性关节内骨折可明显缩短手术时间、提高骨折复位程度、减少切口并发症、提高跟骨骨折内固定手术的疗效。

Objective To evaluate the method and clinical effect of subtalar joint distractor assisted open reduction and internal fixation of comminuted intra-articular calcaneal fracture. Methods Twenty-two patients with fresh closed calcaneal fracture treated with open reduction and internal fixation from May 2011 to July 2013 were included in the study. According to the modes of opera- tion, the patients were randomly divided into two groups （ n = 11 in each） ： in group A patients underwent fracture reduction assisted by subtalar joint distraetor and in group B patients underwent Steinmann pin traction and poking reduction. All were fixed using the lateral calcaneal plate. Operation time, Btihler angle, Gissanes angle, calcaneus height, incision healing time and complications of the two groups were investigated for evaluating the effect of operation. Clinical effect was evaluated using the American Orthopedic Foot ＆ Ankle Society （AOFAS） score before the removal of internal fixation. Results Period of follow-up was （ 14.3 ±0.8）months （range, 12 to 18 months）. Two patients in group B had delayed wound healing, and were treated with regular wound care. At the final follow-up, no infection, nonunion, malunion and internal fixation failure were observed. Bohler angle, operation time and calcaneus height observed in group A were superior to those in group B （ P 〈 0.01 ）. There was no significant difference in Gissanes angle between the two groups （ P 〉 0.05 ）. Compared to the preoperative data, Bohler angle,Gissanes angle and calcaneus height were significantly improved in both groups （ P 〈 0.01 ）. AOFAS score was （83.6 ± 1.4） points in group A and （81.7 ± 1.5） points in group B. Conclusion Subtalar joint distractor assisted open reduction and internal fixation is effective to shorten operation time, improve fracture reduction, reduce wound complications and increase the operative effect for comminuted intra- articular calcaneal fracture.