微创克氏针撬拨复位空心钉内固定治疗跟骨骨折

目的探讨微创经皮克氏针撬拨复位空心钉内固定治疗跟骨骨折的疗效。方法应用经皮克氏针撬拨复位加空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折16例（19足），其中Ⅱ型13例16足，Ⅲ型3例3足。术中侧位透视观察Bohler和Gissane角，Broden位观察后关节面复位情况。围术期常规抗感染。结果16例均得到随访，时间3～15个月，平均（6．3±2．0）个月。骨折愈合时间3．0～4．5个月，平均（3．5±0．3）个月。按照Maryland足部评分：Ⅱ型优14足，良2足；Ⅲ型优1足，良1足，中1足。未见皮缘坏死、腓肠神经损伤，其中Ⅲ型有1足出现针尾皮肤感染（经换药治愈）。结论经皮克氏针撬拨复位加空心钉内固定术，适合于骨折粉碎程度轻、塌陷不严重的跟骨骨折（尤其是SandersII型骨折）、糖尿病患者、下肢血管病变者以及较严重跟骨皮肤挫伤患者，具有术后骨折恢复快、并发症少的优点。

Minimally invasive treatment for calcaneal fractures with percutaneous kirschner wire poking reduction and cannulate screw fixation

Objective To investigate the effect of minimally invasive for calcaneal fractures with percutaneous kirschner wire poking reduction and cannulate screw fixation.Methods Sixteen cases(19 feet) of the SandersⅡ,Ⅲ calcaneal fracture were treated with percutaneous minimally invasive kirschner wire poking reduction and screw fixation.Among them 13 example 16 feet were belong to sanders Ⅱ,3 cases 3 feets were belong to sanders Ⅲ.All of them were assessed Bohler and Gissane angle in lateral view under fluoroscopic guidance,and the congruency of the posterior facet in Broden view during operation.Results The mean follow-up period was(6.3±2.0) months(range from 3 to 15 months) for 16 cases.The fractures were heals at 3.0 to 4.5 months,average for(3.5±0.3) months.All the patients were evaluated by Maryland foot score.The SandersⅡ were excellent in 14 feet,good in 2 feet,excellent in 1 foot.One as good,1 foot as fair in sanders Ⅲ.There was no complication of skin reason necrosis,sural nerve neurotrosis.Infection of needle tail skin occured in 1 case and cured after trades medicine cure.Conclusion Percutaneous minimally invasive reduction and screw fixation technique is a useful method to treat calcaneal fractures with less severe comminuted blocks and less compressive degree cases(in particular the SandersⅡ bone fracture),the diabetes,the patients with lower limb blood vessel pathological change or the serious calcaneum skin contusions.It has a shorter union time and less morbidity complication,compared with the other methods.