经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效

目的：探讨撬拨复位中空钉内固定与切开复位钛板内固定治疗SandersⅡ、Ⅲ型跟骨骨折早期疗效比较。方法总结我科2010年2月～2013年9月跟骨骨折SandersⅡ、Ⅲ型60例，其中Ⅱ型34例，Ⅲ型26例；随机分成两组，分别采用经皮撬拨复位中空钉内固定、切开复位钛板内固定手术治疗,并进行随访观察，采用Marryland 评分系统进行功能评定。统计两种方法的优良率，进行统计学处理，分析两组差异性。结果60例均获得随访，随访时间4～38个月（平均18个月），临床疗效：31例行撬拨复位中空钉内固定者，患足功能优20例，良6例，中2例，差3例，功能优良率83.8％；29例行切开复位钛板内固定者，患足功能优18例，良6例，中3例，差2例，功能优良率82.8％，2种方法优良率比较差异无统计学意义（x2=0.617， P=0.971＞0.05）。结论经皮撬拨复位中空钉内固定与切开复位钛板内固定治疗跟骨骨折均能取得良好的效果；经皮撬拨复位中空钉内固定具有创伤微小，操作简便，固定可靠等优点，可以有效防止严重并发症，是一种临床比较实用有效的治疗方法。

An analysis of the clinical effects of percutaneous fracture reduction followed by internal fixation with multiple axial and horizontal cannulated screws in the treatment of Sanders type II and III calcaneal fracture

ObjectiveTo explore and compare the curative effects of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of Sanders typeⅡ andⅢ calcaneal fracture at early stage.Methods 60 patients with calcaneal fracture from February 2010 to September 2013 were selected. They all belonged to Sanders typeⅡ andⅢ fracture, in which 34 patients were typeⅡ and 26 typeⅢ. All patients were randomly assigned to two groups and received surgeries of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate. They were observed in the follow-ups, and functional evaluation was carried out via Marryland evaluation system. Excellent and good rate of the two methods was calculated, and differences between the two groups were analyzed through statistics. Results Follow-ups were carried out for 60 patients, and the follow-up time was 4-38 months （average 18 months）. Clinical effects： among 31 patients who received percutaneous fracture reduction followed by internal fixation with cannulated screws, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 83.8%; among 29 patients who received open reduction followed by internal fixation with titanium plate, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 82.8%. The differences of the excellent and good rate between the two methods were not statistically significant （x2=0.617,P =0.971〉0.05）.Conclusion Percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of calcaneal fracture can both achieve favorable effects. Percutaneous fracture reduction followed by internal fixation with cannulated screws is minimally invasive, e