小切口保护跟骨外侧骨瓣可吸收钉治疗跟骨骨折的临床评价

目的 探究以"小切口+保护外侧骨瓣+可吸收钉"手术治疗外侧关节面塌陷为主的跟骨骨折手术效果。 方法 2010年1月-2014年1月宁波市第六医院收治的37例(41足)跟骨外侧关节面塌陷为主的骨折患者,术前影像学检查(X线或CT)确诊后,进行小切口掀开外侧骨瓣手术,可吸收钉或克氏针内固定术;骨质疏松、粉碎、关节面塌陷严重等予以一期植骨,术中影像学检查骨折达到或者近似解剖复位。术后进行随访和回顾性分析。纳入研究的临床数据包括:患者年龄、性别、有无其他基础疾病和吸烟史、是否伴有其他复合伤、损伤因素、Sander分型、手术时间、术中出血、手术并发症、骨折临床愈合和功能恢复情况。术后随访复查患者影像学愈合情况、有无感染、骨不愈、内置物失效,患足功能评估采用美国足踝骨科协会(American orthopedic foot & ankle society,AOFAS)的评分系统。 结果 37例患者术后随访12~38个月,平均随访时间18个月。SandersⅡ、Ⅲ、Ⅳ型术前、术后Bohler角和Gissane角差异具有统计学意义(均P<0.05),术后均较术前高;患者手术切口均一期愈合,未出现切口感染、坏死等,AOFAS评分平均84.8分,总的优良率为87.8%(36/41)。 结论 小切口保护跟骨外侧壁骨瓣+可吸收钉治疗外侧关节面塌陷为主的跟骨骨折,缩短手术时间、手术创伤小、降低术后并发症,最大程度的保护跟骨外侧组织结构;同样,可应用于不适合应用跟骨外侧广泛切口内固定的患者,为治疗跟骨骨折提供新的思路。 

Clinical assessment of minimally invasive approach biodegradable screw and protection of the lateral calcaneal bone flap in the treatment of calcaneal fracture

Objective To explore the efficacy and safety of minimally invasive approach biodegradable screw and protection of the lateral calcaneal bone flap in the treatment of calcaneal fracture with the lateral displaced articular fragments. Methods A retrospective study was conducted to analyze the 37 patients of calcaneal fracture with the lateral displaced articular fragments who had been treated with invasive approach biodegradable screw and protection of the lateral calcaneal bone flap at our hospital from January, 2010 to January, 2014. The data were analyzed concerning age, gender, complications of different systems, smoke history, damage factor, fracture type, operation time, bleeding volume, complications of operation, fracture heeling and functional recovery. Results Thirty-seven patients were followed up for 24 to 38 months, average 12 months. The pre-post-operative Bohler's angle and Gissane's angle was significant difference(P<0.05). The degree of postoperative Bohler's angle and Gissane's angle have large than peroperative angles. There were no problems with wound healing or necrosis during the follow-up. The excellent and good rate was 87.8%. Conclusion In treatment calcaneal fracture with the lateral displaced articular fragments, the minimally invasive approach biodegradable screw and protection of the lateral calcaneal bone flap is a successful treatment. The advantages include shorter operation time, limited trauma, and reduced postoperative complications. This technique can be considered in patients who are not suitable for an extensile lateral approach and internal fixation.