距下关节后侧入路关节镜辅助下微创治疗跟骨骨折

目的评价距下关节后侧入路关节镜辅助下闭合复位经皮空心螺钉内固定治疗Essex—Lopresti舌型及SandersⅡA、ⅡB、ⅢAB型跟骨骨折的临床效果。方法2012年6月-2015年6月，收治单侧跟骨骨折16例。男13例，女3例；年龄18—65岁，平均37．8岁。致伤原因：高处坠落伤10例，交通事故伤6例。Essex—Lopresti舌型骨折4例，SandersⅡA型5例、ⅡB型4例、ⅢAB型3例。受伤至手术时间4～8d，平均5．94d。均采用距下关节后外侧、后内侧入路关节镜辅助下闭合复位经皮空心螺钉内固定治疗。手术前后测量Bohler角、Gissane角、跟骨宽度，术后12个月根据美国矫形...

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Published in中国修复重建外科杂志 Vol. 31; no. 1; pp. 36 - 41
Main Author 董福 陆春 朱金荣 李云峰 米琨
Format Journal Article
LanguageChinese
Published 2017
Subjects
关节镜
内固定
微创
跟骨骨折
闭合复位
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Summary:目的评价距下关节后侧入路关节镜辅助下闭合复位经皮空心螺钉内固定治疗Essex—Lopresti舌型及SandersⅡA、ⅡB、ⅢAB型跟骨骨折的临床效果。方法2012年6月-2015年6月，收治单侧跟骨骨折16例。男13例，女3例；年龄18—65岁，平均37．8岁。致伤原因：高处坠落伤10例，交通事故伤6例。Essex—Lopresti舌型骨折4例，SandersⅡA型5例、ⅡB型4例、ⅢAB型3例。受伤至手术时间4～8d，平均5．94d。均采用距下关节后外侧、后内侧入路关节镜辅助下闭合复位经皮空心螺钉内固定治疗。手术前后测量Bohler角、Gissane角、跟骨宽度，术后12个月根据美国矫形足踝协会（AOFAS）踝-后足评分评价踝关节功能。结果术后切口Ⅰ期愈合，无坏死感染、骨筋膜室综合征等并发症发生。术后患者均获随访，随访时间12～15个月，平均13．63个月。术后6个月x线片示骨折线消失，局部无明显压痛及纵向叩击痛，无内固定物断裂及退出，跟骨外侧壁无明显突出，跟骨结节无明显内翻，足弓形态良好，无距下关节融合及腓骨肌腱压迫症状。术后2例发生跟腱激惹，取出内固定物后症状消失；2例发生创伤性关节炎，其中1例症状明显者取出内固定物并行距下关节清理后症状缓解，另1例取钉时未予以关节清理，术后口服塞来昔布症状缓解。术后3d及6个月Bohler角、Gissane角、跟骨宽度均较术前明显改善（P〈0．05）；术后6个月各指标均较术后3d轻度丢失，但差异无统计学意义（P〉0．05）。术后12个月根据AOFAS踝．后足评分评价踝关节功能，获优11例，良3例，中2例，优良率87．5％。结论距下关节后侧入路关节镜辅助下闭合复位经皮空心螺钉固定可有效治疗Essex—Lopresti舌型及SandersⅡA、ⅡB、ⅢAB型跟骨骨折，创伤小、并发症少、功能恢复优良，发挥了微创手术的优势。
Bibliography:51-1372/R
DONG Fu1, LU Chun1, ZHU Jinrong1, LI Yunfeng1, MI Kun2（ 1. Department of Orthopaedics, Beihai People＇s Hospital of Guangxi Province, Beihai Guangxi, 536000, P.R.China 2. The Second Department of Orthopaedics, the First Affiliated Hospital, University of Guangxi Traditional Chinese Medicine, Nanning Guangxi, 530000, P.R. China）
Objective To evaluate the results of arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, IIB, and IIIAB. Methods Sixteen patients with unilateral calcaneal fracture were treated with arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint between June 2012 and June 2015. There were 13 males and 3 females with an average age of 37.8 years （range, 18-65 years）. The injury causes included falling from height in 10 cases and traffic accident in 6 cases. Of 16 cases, 4 were classified as Essex-Lop
ISSN:1002-1892