“竹筏钢板”技术治疗Ⅱ型跟骨鸟嘴骨折的临床观察

Clinical Observation of Bamboo Raft Plate Technique in Treating TypeⅡCalcaneal Bird s Beak Fracture

目的探讨应用“竹筏技术”理念治疗跟骨鸟嘴骨折的临床疗效及安全性。方法系统回顾我院2012年1月至2017年4月期间跟骨鸟嘴骨折住院患者,根据跟骨后结节骨折Beavis分型,其中II型18例,男7例,女11例;年龄42~76岁,平均61.5岁。其中波及距下关节面6例,波及未关节面12例,所有病例均为闭合性损伤,均通过“竹筏原理”进行切开复位内固定术。术后常规随访,均进行X片复查,并运用AOFAS后足及踝评定标准进行评定。结果18例获随访,随访时间8~48个月,平均(11±0.2)个月。其中手术切口均I、II期愈合,皮瓣坏死1例(腓肠神经血管皮瓣移植后愈合),无感染性骨髓炎、腓肠神经损伤,按AOFAS评定标准:优11例,良6例,中:1例:差:0例,优良率为94.4%;总体平均得分(91.0±2.8)。结论跟骨鸟嘴骨折是足踝部骨折急诊手术之一,如何减少皮瓣坏死、骨折移位丢失、早期功能锻炼是临床治疗的难题与重点,通过有限切开复位结合钉筏钢板螺钉技术内固定术,能直观复位、有效固定、避免复发撬拨骨质丢失及软组织损伤等优点,值得临床进一步推广。

Objective To explore the clinical efficacy and safety of applying the concept of bamboo raft technique in the treatment of calcaneal beak fractures.Method From January 2012 to April 2017,hospitalized patients with calcaneal beak fractures in our hospital were systematically reviewed.According to Beavis classification of posterior calcaneal tubercle fractures,18 cases were type II,7 were males,11 were females.Age was 42~76 years old,with an average of 61.5 years old.Among them,6 cases affected the subtalar articular surface and 12 cases affected the non-articular surface.All cases were closed injuries that bamboo raft principle was used for open reduction and internal fixation.After operation,X-ray re-examination was performed to routinely follow up,and AOFAS hind foot and ankle evaluation standard was used for evaluation.Results 18 cases were followed up for 14 to 48 months,with an average of(11±0.2)months.The surgical incisions healed by stage I and II,1 case of flap necrosis(healed after sural nerve and blood vessel flap transplantation),no infectious osteomyelitis and sural nerve injury.According to AOFAS evaluation criteria,excellent had 11 cases,good had 6 cases,medium had 1 case,poor had 0 case.Moreover,the excellent and good rate was 94.4%,overall average score was(91.0±2.8).Conclusion Calcaneus beak fracture is one of the emergency operations for foot and ankle fractures.It is difficult and important to reduce skin flap necrosis and fracture displacement loss,and early functional exercise.Through limited open reduction and internal fixation with nail-raft plate screw technology,it could reset intuitively,fix effectively,avoid bone recurrence loss and soft tissue damage that it is worthy of further clinical promotion.