经跗骨窦入路拉力螺纹钉加克氏针内固定治疗跟骨关节内骨折

目的:探讨经跗骨窦入路拉力螺纹钉加克氏针内固定治疗跟骨关节内骨折的临床疗效.方法:采用经跗骨窦入路克氏针加拉力螺纹钉内固定术治疗跟骨关节内骨折31例(42侧),其中Sanders分型II型23侧,III型17侧,IV型2侧.术后4周拔除外露克氏针,术后6～12个月去除拉力螺纹钉.结果:术后并发切口皮缘坏死2例,经清创换药后,局麻下直接缝合治愈.术后随访8.5～25个月,平均12.7个月.所有患者跟骨后关节面复位满意,跟骨外形及高度恢复满意,但部分患者跟骨宽度恢复不满意.根据Maryland后足功能评价标准,本组90～100分18侧,80～90分12侧,70～80分9侧,60～70分3侧.结论:经跗骨窦入路拉力螺纹钉加克氏针内固定术具有显露充分、复位满意、内固定可靠、软组织创伤小、切口感染风险低等优点,是治疗跟骨关节内骨折的方法之一.

Treatment of Intra-articular Fracture of the Calcaneum by Lag Screw and K-wire through Sinus Tarsi Approach

Objective： To observe the operative treatment of intra - articular fracture of the calcaneus by K -wire and lag screw through the sinus tarsi approach. Methods：31 patients with 42 calcaneal fractures were treated with K - wire and lag screw through sinus tarsi approach. According to Sanders classification, there were 23 type Ⅱ fractures, 17 type Ⅲ fractures and 2 type Ⅳ fractures. The K - wires were pulled out at 4 weeks after operation. The lag screws were pulled out from 6 to 12 months after operation. Results：Two cases had incision - edge necrosis and treated by dress - changing and direct suture at the second stage. All of the cases had follow- up from 8.5 -25 months （averaged 12.7 months）. The reduction of the posterior facet was graded as nearly anatomical （less than 3 mm articular displacement） in all cases. The conture and height of the calcaneus were regained satisfactorily, but the width was not regained satisfactorily in some patients. According to Maryland hindfoot scoring system, 18 feet scored 90 - 100 points, 12 feet scored 80 -90 points, 9 feet scored 70 -80 points and 3 feet scored 60 -70 points. Conclusions ： Sinus tarsi approach with K - wire and lag screw fixation is one of the methods for the treatment of intra - articular calcaneal fracture. It has adequate exposure, satisfactory reduction, reliable internal - fixation, minimal soft tissue damage and little risk of wound complications.