双向贴近式空心螺钉治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究

Sanders,a Two-way Close Type Hollow Screws for the Treatment ofⅡ,ⅢCalcaneal Fractures of the Clinical Research

目的:探讨双向贴近式空心螺钉治疗SandersⅡ、Ⅲ型跟骨骨折的疗效研究。方法:通过撬拔结合手法复位跟骨骨折块并通过经皮双向贴近式空心螺钉固定治疗跟骨骨折28例,比较患者手术前和术后半年Bohler角、Gissanes角、跟骨宽度变化以及骨折愈合时间,并按Maryland足部功能评分进行评估,观察术后患者有无并发症的发生。结果:患者术后均获得随访,时间9~12个月。术后半年Bohler角由术前0°~8°,平均(3.6°±1.0°)改善为25°~32°,平均(27.2°±1.7°);Gissanes角由术前158°~169°,平均(163°±1.3°)改善为123°~147°,平均(133.6°±7.5°);跟骨宽度由术前36~41mm,平均(37.3±3.5)mm改善为28~33mm,平均(30.2±3.0)mm;所有术后患者均达到骨折愈合,骨折愈合时间11~13周,平均(12.2±0.7)周;术后半年Maryland足部功能评分为74~96分,其中优20例,良7例,可1例;所有患者术后均未出现切口感染,末次随访皆未发现跛行。结论:通过撬拔复位双向贴近式空心螺钉固定跟骨骨折具有固定牢靠、创伤小、足踝功能恢复快等优点,同时通过轴向和横向两枚螺钉的贴近搭接,近似完成了跟骨的三点固定,达到增加固定强度,预防关节面再次塌陷的目的,有一定的临床推广价值。

Objective:To study the effect of two-way close type hollow screw in the treatment of SandersⅡandⅢcalcaneus fracture.Methods:28 cases of calcaneal fracture were treated by prying and pulling combined with manual reduction and percutaneous two-way close type hollow screw fixation.The changes of Bohler angle,gissanes angle,calcaneal width and fracture healing time were compared before and half a year after operation,and the postoperative evaluation was made according to Maryland foot function score to observe the occurrence of complications.Results:all patients were followed up for 9-12 months.Half a year after operation,Bohler angle was improved from 0°-8°(3.6±1.0)to 25°-32°(27.2±1.7°);gissanes angle was improved from 158°-169°(163±1.3)to 123°-147°(133.6°±7.5°);calcaneus width was improved from 36-41(37.3±3.5)mm to 28-33(30.2±3.0)mm;all patients achieved fracture healing after operation,and fracture healing time was 11-13 weeks(12.2±0.7)weeks after operation,Maryland’s foot function score was 74-96 in half a year,including 20 excellent cases,7 good cases and 1 fair case.All patients had no incision infection and no claudication was found in the last follow-up.Conclusion:the fixation of calcaneus fracture with two-way close type hollow screw has the advantages of firm fixation,little trauma and quick recovery of ankle function.At the same time,the three-point fixation of calcaneus is approximately completed by the close lap of axial and transverse two screws,so as to increase the fixation strength and prevent the joint surface from collapsing again,which has certain clinical value.