3D打印辅助跗骨窦入路空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折

Treatment of Sanders typeⅡandⅢcalcaneal fractures with 3D printing assisted cannulated screw internal fixation via tarsal sinus approach

目的探讨3D打印辅助跗骨窦入路空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法采用3D打印辅助跗骨窦入路空心钉内固定治疗18例SandersⅡ、Ⅲ型跟骨骨折患者。记录手术时间、骨折复位质量、骨折愈合情况、影像学观察指标(跟骨长度、高度、宽度及B9hler角、Gissane角)、踝关节活动度。采用AOFAS踝-后足评分评价临床疗效。结果患者均获得随访,时间10~12个月。手术时间45~60 min。骨折均解剖复位,对位对线良好。骨痂形成时间6~8周,骨折愈合时间12~18周。影像学观察指标术后10个月均优于术前(P<0.05)。末次随访时,踝关节背伸12°~20°、跖屈36°~45°;采用AOFAS踝-后足评分评价临床疗效:优16例,良2例,优良率18/18。结论3D打印辅助跗骨窦入路空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折,符合现代骨科微创治疗理念,具有软组织损伤小、切口并发症发生率低、有效恢复跟骨解剖学参数、维持骨折断端稳定的优点。

Objective To investigate the effect of treatment of Sanders typeⅡandⅢcalcaneal fractures with 3D printing assisted cannulated screw internal fixation via tarsal sinus approach.Methods The 18 patients of Sanders typeⅡandⅢcalcaneal fractures were treated with 3D printing assisted cannulated screw internal fixation via tarsal sinus approach.The operation time,quality of fracture reduction,fracture healing,imaging indicators(the calcaneal length,height,width,and B hler angle,Gissane angle),ankle range of motion were recorded.The clinical effect was evaluated according to the AOFAS ankle-hindfoot function score system.Results All patients were followed up for 10~12 months.The operation time was 45~60 min.All fractures were anatomically reduced with good alignment.The time of callus formation was 6~8 weeks,the time of fracture healing was 12~18 weeks.The imaging indicators at 10 months postoperatively were all better than the preoperation(P<0.05).At the last follow-up,the dorsiflexion angle of ankle joint was 12°~20°,plantar flexion was 36°~45°.The clinical effect was evaluated according to AOFAS ankle-hindfoot function scoring system:excellent in 16 cases,good in 2,with the excellent-good rate of 18/18.Conclusions For treatment of Sanders typeⅡandⅢcalcaneal fractures,3D printing assisted cannulated screw internal fixation via tarsal sinus approach accords with the modern orthopaedics minimally invasive treatment concept,which has the advantages of less soft tissue injury,low incisional complication rate,effective recovery of calcaneal anatomic parameters and maintaining stability of fractures.