跟骨骨折；_关节内；_撬拨复位；_多枚斯氏针；

经皮撬拨复位多枚斯氏针轴向内固定治疗跟骨骨折

http://www.100md.com 《新疆医科大学学报》(新) 2006年第10期

跟骨骨折；,关节内；,撬拨复位；,多枚斯氏针；,内固定,,跟骨骨折；,关节内；,撬拨复位；,多枚斯氏针；,内固定,1资料与方法,2结果,3讨论,参考

     摘要: 目的: 探讨经皮撬拨复位多枚斯氏针轴向内固定治疗跟骨骨折的疗效。方法: 采用经皮撬拨复位多枚斯氏针轴向内固定技术治疗跟骨骨折14侧，右侧9侧，左侧5侧；高处坠落伤12例，摔伤1例，均为闭合性骨折。Sanders分型Ⅱ型 5例,Ⅲ型7例,Ⅳ型2例。采用Maryland foot score系统对其优良率进行评价，并观察Bhler角和Gissane角的变化。结果: 14侧手术顺利，达到或接近解剖复位，1侧由于中间骨折块未能达到复位要求，辅助小切口复位骨折块。14侧Bhler角由术前12.6°增加到38.5°，Gissane角由术前的75°增加到术后的114.5°，手术前、后差异有统计学意义(P<0.01)。随访8~26个月，平均12个月，术后4个月骨折全部愈合。评分优良率为85.7%。无一例发生软组织和骨折再移位等并发症，足外形良好，能够穿正常鞋，无跛行。结论:经皮撬拨复位多枚斯氏针轴向内固定适用于SandersⅡ型、Ⅲ型及Ⅳ型跟骨骨折的治疗，可获得良好的复位和可靠固定，并明显降低软组织损伤等并发症的发生率，是一种有效、可行的微创治疗方法。

    关键词: 跟骨骨折；关节内；撬拨复位；多枚斯氏针；内固定

    Percutaneous reduction by leverage and axial fixation with multiple Steinmann′s pins to treat fracture of calcaneus

    Fulati·Maimaiti, SHENG Weibin, CAO Li, et al

    (Department of Orthopaedics, First Affiliated Hospital, Xinjiang Medical University,Urumqi 830054, China)

    Abstract: Objective: To evaluate the outcome of percutaneous reduction by leverage and axial fixation with multiple Steinmann′s pins to treat fracture of calcaneus. Methods: From Jan 2004 to June 2005, 14 patients with fracture of calcaneus were treated by percutaneous reduction by leverage and axial internal fixation with multiple Steinmann′s pins. 11 cases (12 sides) were males and 2 cases (2 sides) were females. All the fractures were closed. According to Sanders′ classification, 5 cases were type Ⅱ fracture and 7 cases were type Ⅲ fracture and 2 cases were type Ⅳ fracture. Result: All the patients were treated percutaneous reduction and obtained good resuld except one patient who needs another small incision to help reduction and bone graft. The preoperative Xray film showed that the Bhler angle was 12.6°, Gissane angle was 75°. The postoperative Xray film demonstrated that Bhler angle was 38.5°, Gissane angle was 114.5°. The statistical difference was significant (P<0.001). Followingup of 13 patients (14 sides) was 12 months (range, 8~26 m). All fractures healed 4 months after operation. According to Maryland foot score system, excellent and good rate was 85.7% and there are no soft tissue complications and fracture redisplacement occurred. The shape of the foot is good and the patient can walks normally with no pain and claudication. Conclusion: Percutaneous reductiore by leverage and axial fixation with multiple Steinmann′s pins is an effective and micro invasive method in treatment of Sanders′ type Ⅱ, type Ⅲ , type Ⅳ fractures of calcaneus. The technique can obtain good reduction and stable fixation with low operation complication. ......

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