目的 探讨小切口下撬拨复位、克氏针内固定治疗跟骨关节内压缩性骨折的临床效果。 方法 2012年6月~2016年10月采用外踝下小切口撬拨复位、克氏针内固定治疗15例跟骨关节内压缩性骨折患者，术前CT示关节面塌陷均＞2 mm，根据Sanders分型I型3例，Ⅱ型10例，Ⅲ型2例；观察切口长度、手术时间等一般情况，X线测量Bohler角和Gissane角，三维CT了解关节面复位及再次塌陷情况。踝关节功能根据Maryland足部功能评分标准进行评价。 结果 手术切口3~5 cm，平均3.8 cm；手术时间32~56 min，平均42 min；术中出血量10~30 mL，平均18 mL。术后切口均I期愈合。术后即刻Bohler角、Gissane角分别为（34.1±4.1）o、（128.4±2.9）o，术后1年分别为（33.9±4.2）o、（128.3±2.7）o，两时间点比较差异均无统计学意义。术后即刻关节面解剖复位率为93.3%。末次随访时踝关节功能优良率为92.9%。 结论 外踝下小切口撬拨复位、克氏针内固定治疗跟骨关节内压缩性骨折能充分显露关节面，具有手术损伤小、操作简便、经济实用、并发症少，踝关节功能恢复满意等优点。
Abstract
Objective To explore the clinical effect of minimal incision, poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus. Methods From June 2012 to October 2016, 15 patients with compressive intra-articular fractures of calcaneus were included. All 15 patients with articular surface collapse＞2 mm underwent minimal incision poking reduction and Kirschner wire internal fixation. The incision length, surgical duration, incision healing, fracture healing, loss of articular surface reduction, and ankle joint function were used for evaluation. The Bohler angle and the Gissane angle were measured in X-ray. The three-dimensional CT was used to measure the articular surface reduction and re-collapse. Ankle function was evaluated according to the Maryland Foot Function Rating criteria. Results The incision length was 3~5 cm, surgical duration was 32~56 min, intraoperative blood loss was 10~30 mL, and the incision healed smoothly. There was no significant difference in Bohler angle and Gissane angle immediately and 1 year after operation. The anatomic reduction ratio of articular surface was 93.3%. According to Maryland Foot Score system, 10 cases were rated as excellent, 3 as good, 1 as fair, and the rate of excellent and good outcomes was 92.9%. There were no significant differences in the Bohler angle and Gissane angle immediately after surgery and the last follow-up (P>0.05). Conclusion The minimal incision poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus can expose fully. It has the advantages of small injury, easy operation, less complications, and satisfactory ankle function.
关键词
跟骨关节内骨折 /
压缩性骨折 /
撬拨复位 /
小切口 /
克氏针内固定
Key words
Intra-articular fractures of calcaneal /
Compressive fractures /
Poking reduction /
Minimal incision /
Kirschner wire internal fixation
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