微创经皮钢板固定技术在跟骨关节内骨折治疗中的应用

Therapy of Displaced Intra-articular Calcaneal Fractures by Using Minimally Invasive Percutaneous Plate Osteosynthesis Technology

目的探讨微创经皮钢板固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术治疗移位的跟骨关节内骨折的方法及效果。方法自2011-08/2013-10月,采用MIPPO技术治疗有移位的跟骨关节内骨折43例45足。骨折采用Sanders分型:Ⅱ型骨折34足,Ⅲ型骨折11足,手术入路应用外侧跗骨窦切口结合跟腱前缘直行小切口,采用跟骨外侧解剖接骨板固定。应用影像学检查和美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)的后足评分系统进行结果评价。结果 43例患者均获随访,平均随访时间17.8个月(12~26个月)。术前平均Bhler角是7.0°,随访时平均Bhler角是29.4°,术前平均Gissane角是98.5°,随访时平均Gissane角是119.4°。术后无伤口皮缘坏死或切口感染发生。AOFAS踝-后足评分为70~100分,优35足,良7足,一般3足,差0足,总优良率为93.3%。其中SandersⅡ型骨折平均评分为92分,SandersⅢ型骨折平均评分为82分。SandersⅡ型骨折优良率为94.1%,SandersⅢ型骨折优良率为90.9%。结论应用MIPPO技术治疗SandersⅡ型和Ⅲ型跟骨骨折获得了满意的临床疗效,并可有效避免术后并发症的发生。

Objective To explore the method and efficacy of the treatment for displaced intra-articular calcaneal fractures by using the technology of minimally invasive percutaneous plate osteosynthesis(MIPPO).Methods From August 2011 to October 2013,43 patients with 45 fractures were treated by MIPPO technology.Among these fractures,according to Sanders classification,34 fractures were typeⅡ,11 were typeⅢ.All 45 fractures were treated by calcaneal anatomical plate via the sinus tarsi incision and the straight incision of achilles tenden.All patients were evaluated using radiographic examinations and the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society(AOFAS).Results All 43 patients got followed up with an average time of 17.8 months(range,12-26 months).Average Bhler's angle was 5.7°preoperatively and 29.4°finally.Average Gissane angle was 98.5°preoperatively and 119.4°finally.There was no incision edge necrosis or wound infection.According to the AOFAS foot score,the overall excellent and good rate was 93.3%(42/45).The average score was 92 for typeⅡfractures,and 82 for typeⅢfractures.The excellent and good rate was 94%for typeⅡ fractures,and90%for typeⅢ fractures.Conclusion Treating of displaced intra-articular calcaneal fractures by MIPPO technology not only achieves satisfactory clinical therapeutic effects,but also effectively avoids postoperative complications.