顶拔撬拨闭合复位空心钉内固定联合小切口植骨填充术治疗SandersⅡ-Ⅳ型跟骨骨折临床观察

摘要

Objective To evaluate the top pull poking cannulated screw fixation combined with small incision bone augmentation therapy Sanders Ⅱ-Ⅳ calcaneal fractures.Method C-arm machine with closed reduction and fixation ,plus a small incision implantation of autologous cancellous bone ,cannulated screw fixation of dis-placed intra-articular calcaneal fracture 62 cases,of which SandersⅡtype 48 cases(ⅡA type 25 cases,ⅡB Type 20 cases,ⅡC type 3 cases ) ,SandersⅢ8 cases, Sanders Ⅳ type in 6 cases.Results 62 patients with no postoperative superficial skin flap necrosis,immune rejection,infection and other complications,56 cases after 3-24 months(mean 8 months)follow-up,all patients were healed,Maryland Foot Grading:excellent in 40 cases,good in 14 cases,2 cases.Excellent rate of 96.42%. Conclusion Top pull poking closed reduction cannulated screw fixation combined with small incision bone augmentation therapy is a more practical clinical treatment . Minimally invasive treatment to achieve the purpose .Can effectively restore the anatomy of the articular surface of the calcaneus .Restore full function better and stable fixation,minimal complications.%目的：评价顶拔撬拨空心钉内固定联合小切口植骨填充术治疗SandersⅡ-Ⅳ型跟骨骨折的疗效。方法 C形臂机下闭合复位固定，再加小切口植入自体松质骨，空心钉内固定治疗移位跟骨关节内骨折62例，其中 SandersⅡ型48例（ⅡA 型25例，ⅡB 型20例，ⅡC 型3例），SandersⅢ型8例， SandersⅣ型6例。结果62例患者术后无皮缘表浅坏死、免疫排斥、感染等并发症，56例经3-24个月（平均8个月）的随访，所有病例均获骨性愈合，按Maryland足部评分标准：优40例，良14例，可2例，优良率96．42％。结论顶拔撬拨闭合复位空心钉内固定联合小切口植骨填充术治疗是一种临床较实用的治疗方法，能够达到微创治疗的目的，能有效恢复跟骨关节面的解剖形态。较好地恢复足的功能，且固定牢靠、并发症极少。