经皮撬拨复位螺钉内固定治疗跟骨关节内骨折

目的 探讨经皮撬拨复位微创螺钉内固定治疗跟骨骨折的疗效和技术要点.方法 2006年3月至2010年4月作者采用经皮撬拨复位微创空心拉力螺钉结合松质骨螺钉,部分患者联合注射高黏度液体人工替代骨或颗粒骨填充治疗21 例24侧跟骨骨折,男17 例,女4 例;年龄21～67 岁,平均年龄38.3 岁.其中18 例为单侧,3 例...

Percutaneous Reduction and Screw Fixation of Displaced Intra-articular Calcaneus Fractures with Artificial Bone

Objective The purpose of this study is to assess the results of the technique of the percutaneously reducing and fixing calcaneus fractures.Methods Twenty one patients with 24 intra-articular calcaneus fractures which were 17 males and 4 females,were treated with percutaneous reduction and screw fixation with artificial bone in small incisions from March in 2006 to April in 2010.There were nine calcaneus Fractures with TypeⅡ,fourteen with TypeⅢ,and one with Type Ⅳ.Results The Bo¨hler′s angle was improved after surgery by an average of 24.21°,and the Gissane′s angle was declined after surgery by an average of 26.63°.There was significantly different between the pre-operation and post-operation both in Bo¨hler′s angle and Gissane′s angle.The Bo¨hler′s angle,Gissane′s angle,calcaneal width and height were reduced close to the values of the uninjured side or normal anatomic structure in X-ray.All of these patients were followed a minimum of 7 months（mean,12.7 months;range,7~14 months）.The average loss of reduction during healing（minimum 7 months postoperatively） was less than 2 mm.We observed no deep infection,minor wound complications or traumatic osteoarthritis occurred in all of the 24 intra-articular calcaneus fractures.The average American Orthopaedic Foot and Ankle Society ankle-hindfoot score at last follow-up was 93.5（range,80~100）.Conclusion The results of this study suggest that this method of percutaneously reducing and fixing calcaneus fractures with screws and artificial bone can be used to achieve satisfactory results with minimal risk of complication.Further study of this technique is warranted.This should include comparison with the standard extensile open reduction and longer follow-up of a larger number of patients which include more Type Ⅳ.We believe percutaneous reduction and screw fixation with artificial bone is a reasonable alternative for displaced TypeⅡ and TypeⅢ,whether it is reasonable for Type Ⅳ needs more study.