| 徐谦,何健飞,王强茂,等.延长的跗骨窦切口置入钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折.骨科,2017,8(1): 20-24. |
| 延长的跗骨窦切口置入钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折 |
| Internal fixation with plate of Sanders Ⅱ-Ⅲ of calcaneus fractures using an extended sinus tarsi approach |
| 投稿时间：2016-04-15 |
| DOI：10.3969/j.issn.1674-8573.2017.01.006 |
| 中文关键词: 跟骨 关节内骨折 经跗骨窦切口 骨折固定术，内 |
| 英文关键词: Calcaneus Intra-articular fractures Sinus tarsi approach Fracture fixation, internal |
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| 中文摘要: |
| 目的 探讨经延长的跗骨窦切口置入跟骨钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效。方法 自2013年3月至2015年4月，我院在原跗骨窦入路基础上采用切口延长的办法，置入钢板内固定治疗跟骨关节内骨折29例（37足），其中男21例，女8例；年龄为19~55岁，平均30.3岁。骨折按Sanders分型：Ⅱ型26足，Ⅲ型11足。根据Essex-Lopresti分型，均为伴有明显移位的跟骨关节外骨折。将手术前后的跟骨高度、宽度、长度、Böhler角和Gissanes角进行比较，术后半年按Maryland足部功能评分系统评价疗效。结果 本组29例均获得随访，随访时间为6~18个月，平均8.2个月。术后无切口并发症发生；骨折愈合时间为3~6个月，平均4.3个月。本组37足术前的跟骨高度、宽度、长度、Böhler角以及Gissanes角分别为（34.7±3.4） mm、（38.7±4.6） mm、（65.1±3.7） mm、20.9°±7.5°、99.5°±10.6°；术后1周时的各项数值分别为（38.1±2.2） mm、（33.4±2.7） mm、（67.8±4.5） mm、29.8°±4.7°、119.4°±8.4°；手术前后各项指标比较，差异均有统计学意义（均P＜0.05）。术后半年随访时，采用Maryland足部功能评分系统对患足功能进行评价：优25足，良9足，可3足，优良率为91.9%。结论 对于跟骨Sanders Ⅱ、Ⅲ型骨折特别是合并跟骨关节外明显移位的骨折，经延长的跗骨窦切口置入跟骨钢板的内固定手术不仅可以获得充分的显露，准确的复位与固定，而且可早期手术并避免切口并发症，弥补了传统手术入路的不足，便于基层医院开展。 |
| 英文摘要: |
| Objective To investigate the clinical effects of internal fixation with plate of Sanders Ⅱ-Ⅲ of calcaneus fractures using an extended sinus tarsi approach. Methods From March 2013 to April 2015, 29 cases (37 feet) were treated by internal fixation with plate using an extended incision based on a sinus tarsi approach. There were 21 males and 8 females, aged from 19 to 55 years old (mean 30.3 years old). According to Sanders classification system, there were 26 feet with type Ⅱ, and 11 feet with type Ⅲ. According to Essex-Lopresti classification system, all feet suffered from extra-articular displaced fractures. The calcaneal indices, including height, width, length, Böhlers angle and Gissanes angle, were compared before and after operation. At 6th month after operation, the clinical results were evaluated with the Maryland foot score system. Results All 29 cases were followed up for 6-18 months (mean 8.2 months). There were no early wound complications postoperatively. The time of fracture healing was 3 to 6 months (mean 4.3 months). The calcaneal height, width, length, Böhlers angle and Gissanes angle after operation were (38.1±2.2) mm, (33.4±2.7) mm, (67.8±4.5) mm, 29.8°±4.7°, and 119.4°±8.4°, significantly different from those before operation ［(34.7±3.4) mm, (38.7±4.6) mm, (65.1±3.7) mm, 20.9°±7.5°, and 99.5°±10.6°］ (P＜0.05 for all). According to the Maryland foot score system, there were excellent results in 25 feet, good in 9 feet, fair in 3 feet with the excellent and good rate of 91.9%. Conclusion For treatment of Sanders Ⅱ-Ⅲ of calcaneus fractures, internal fixation with plate by an extended sinus tarsi approach can obtain good reduction and stable fixation, full exposure, and earlier operation. It can effectively avoid postoperative complications, make up for the deficiency of conventional surgical methods and achieve satisfactory clinical therapeutic effects, especially in the primary hospitals. |
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