经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersH、IH型跟骨骨折的临床效果分析

【摘要1目的探讨经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、III型跟骨骨折的效果。方法选取本院2009年1月～2012年5月采用经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折患者104例（113足），对手术患者随访，评定手术疗效及分析影响疗效的因素。结果治疗前后患者的Bhler角、Gissane角、结节部高度、丘部高度、轴长、水平长和宽度比较，差异有统计学意义（P〈0．05）。治疗后优48足，良54足，可9足，差2足，优良率为90．26％。单因素分析显示术后BShler角、Gissane角、损伤机制和手术时间是影响手术疗效的相关因素（P〈0．05）。多因素分析显示术后Bhler角、Gissane角、损伤机制和手术时间是影响手术疗效的相关因素（P〈0．05）。结论经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、llI型跟骨骨折效果肯定，能较好地恢复Bhler角、Gissane角，整复距下、跟骰关节面，恢复跟骨体的长度、高度、宽度；研究发现B~hler角、Gissane角、损伤机制及手术时间可影响跟骨骨折的疗效，临床上应重视这些因素。

Clinical effect analysis of percutaneous bined with horizontal number of hollow poking reduction and axial com- nail internal fixation in the treat- ment of Sanders H and HI type calcaneal fracture

Objective To study the effects of percutaneous poking reduction and axial combined with horizontal number of hollow nail internal fixation in the treatment of Sanders II and III type calcaneal fracture. Methods 104 cases（ll3 feet）with Sanders I1 and m type calcaneal fracture in our hospital from January 2009 to May 2012 were selected and followed-up,operation effect was evaluated and the factor influencing the curative effect was analysed. Results Before and after treatment,the BShler angle,Gissane angle,height,height of nodules hill,long axis horizontal long, calcaneal width of patient was compared respectively,with statistical difference（P〈0.05）.Mter treatment,48 feet was excellent,54 feet was good,9 feet was general,2 feet was poor,fine rate was 90.26%.Single factor analysis showed that the postoperative Bihler angle,Gissane angle,the damage mechanism and operation time is the related to operation efficacy （P〈0.05）.Multivariate analysis showed that the postoperative Bthler angle,Gissane angle,the damage mechanism and operation time is the re- lated to operation efficacy （P〈0.05）. Conclusion The effect of pei＇cutaneous poking reduction combined with horizontal axial cannulated screw fixation in the treatment of Sanders H and HI type callcaneal fracture is certain,which can re- store the B bhler angle,Gissane angle,reconstruct subtalar and calcaneocuboid joint surface,restore body length,height and width.Studies have found that Bhler angle,Gissane angle,the injury mechanism and operation time can affect the curative effect of calcaneal fracture,clinical attention should be paid to these factors.