载距突螺钉导向器在跟骨载距突螺钉置钉中的应用

背景：跟骨关节内骨折手术治疗时准确置入载距突螺钉可获得最佳固定效果。但由于跟骨复杂的解剖特点和术中有限的X线透视效果,完成载距突螺钉的准确置钉工作难度极大。而准确置入载距突螺钉的方法仍存较大争议。目的：探讨跟骨关节内骨折手术治疗时使用跟骨载距突螺钉导向器辅助载距突螺钉的准确置钉效果。方法方法：回顾性分析2010年7月至2013年12月手术治疗的42例（48足）跟骨关节内骨折病例,男35例,女7例;年龄15-67岁,平均38.9岁。根据Sanders分型：Ⅱ型22足,Ⅲ型19足,Ⅳ型7足。所有手术均采用跟骨外侧入路,术中使用跟骨载距突螺钉导向器辅助置入跟骨载距突螺钉。术后复查X线与CT,验证螺钉置入载距突的准确性。结果：42例患者术后随访7-28个月,平均17.4个月。按美国足踝外科协会Maryland足部功能评分标准进行功能评定：优21足,良19足,可8足,差0足;术后Maryland足部评分平均为87.8分,优良率83.3%。共置入53枚载距突螺钉。1枚螺钉从跟骨后关节面内下方露出部分螺纹,1枚螺钉从载距突前方穿出,1枚螺钉穿出载距突关节面进入距跟中关节,1枚螺钉远端一半螺纹在载距突下方露出,余49枚螺钉位于载距突内;螺钉置入精确率为92.5%（49/53）。结论：跟骨载距突螺钉导向器能辅助术者从跟骨外侧入路准确完成载距突螺钉置钉。

Application of a screw drilling device for screw placement in sustentaculum tali in patients with calcaneus fractures

Background： Precise placement of screw in sustentaculum tali is essential for strong fixation of calcaneus fractures. But this procedure is very difficult because of complicated anatomic configuration of the calcaneus and limited visualisation in intraoperative fluoroscopic images. And surgical methods of precise placement of screw in sustentaculum tali are still in dispute.Objective： The aim of this study is to evaluate the accuracy of screw placement by using a sustentaculum tali screw drilling device in calcaneus fractures.Methods： From July 2010 to December 2013, a total of 42 patients（48 feet） undergone surgical treatment of intraarticular calcaneal fractures. There were 35 males and 7 females with an average age of 38.9 years（range, 15-67 years）. According to Sanders classification, 22 feet were classified as typeⅡ, 19 feet as type Ⅲ and 7 feet as type Ⅳ. All operations were performed through calcaneal lateral approach. A modified screw drilling device was used for screw placement in sustentaculum tali. Postoperative X-ray and CT scan of the affected feet were reviewed to verify the accuracy of screw placement.Results： Average follow-up period of the 42 patients was 17.4 months（range, 7-28 months）. Marylandfoot score was used to evaluate clinical outcomes： excellent in 21 feet, good in 19 feet, fair in 8 feet, and average Maryland foot score was 87.8.A total of 53 screws were implanted in sustentaculum tali. Complications happened in 4 feet during screw implantation and the accuracy of screw implantation was 92.5%（49/53）.Conclusions： The screw drilling device can precisely assist surgeon in screw placement in sustentaculum tali through lateral approach for treatment of calcaneal fracture.