跗骨窦切口经皮撬拨空心钉内固定治疗Sanders Ⅱ型跟骨骨折

Percutaneous poking cannulated screw fixation and minimally invasive in treatment of Sanders type Ⅱ calcaneal fracture via calcaneal sinus incision

目的探讨跗骨窦切口经皮撬拨空心钉内固定治疗SandersⅡ型跟骨骨折的疗效。方法采用跗骨窦切口经皮撬拨空心钉内固定治疗28例SandersⅡ型跟骨骨折患者,术后摄X线片评估跟骨关节面、高度、宽度、B9hler角、Gissane角,按疼痛VAS评分和AOFAS踝-后足评分标准评价疗效。结果手术时间25～45min。患者均获得随访,时间12～34个月。骨折愈合时间为10～15(12. 4±2. 3)周。术后12个月,跟骨高度由术前32～40(36. 5±3. 8) mm改善为39～43(41. 2±1. 6) mm;跟骨宽度由术前38～44(40. 3±3. 9) mm改善为30～34(32. 2±1. 8) mm; B9hler角由术前0°～9°(4. 5°±0. 9°)改善为25. 5°～32. 5°(29. 1°±1. 8°); Gissane角由术前150°～175°(158. 7°±6. 9°)改善为125°～145°(132. 6°±7. 8°);踝关节负重状态下疼痛VAS评分为1～3(1. 6±0. 4)分;并发症发生率为1/28。术后12个月,AOFAS踝-后足评分为72～93分,其中优20例,良7例,可1例。结论跗骨窦切口经皮撬拨空心钉内固定治疗SandersⅡ型跟骨骨折,具有操作简单、创伤小、并发症少等优点。

Objective To investigate the effect of percutaneous poking cannulated screw fixation and minimally invasive for Sanders type Ⅱ calcaneal fracture through calcaneal sinus incision. Methods The 28 patients with Sanders type Ⅱ calcaneal fracture were treated by percutaneous poking cannulated screw fixation. The articular surface,height,width, B hler angles and Gissane angles of the calcaneus were evaluated. Pain VAS and AOFAS ankle-hindfoot scale evaluation were performed in every patient. Results The operation time was 25~45 min. All patients were followed up for 12~34 months. The fracture was healed in 10~15（12.4±2.3） weeks.At postoperative 12 months,the calcaneal height was improved to 39~43 （41.2±1.6） mm from preoperative 32~40 （36.5±3.8） mm, and the calcaneal width was improved to 30～34（32.2±1.8）mm from preoperative 38～44（40.3±3.9）mm, B hler angle was improved to 25.5°～32.5°（29.1°±1.8°） from preoperative 0°～9°（4.5°±0.9°）,and Gissane angle was improved from preoperative 150°～175°（158.7°±6.9°） to 125°～145°（132.6°±7.8°）.The VAS at ankle weight-bearing state was 1~3（1.6±0.4）points.The complication incidence rate was 1/28. At 12 months after operation, the AOFAS ankle-hindfoot scale was 72~93 points, 20 cases were excellent, 7 good,1 fair. Conclusions Poking cannulated reduction and connulated screw fixation for Sanders Ⅱ calcaneal fracture has simple operation,less trauma and postoperative complications.