关节镜直视下Sanders II~III跟骨骨折复位内固定

Arthroscopy- assisted reduction and percutaneous cannulated screw fixation for Sanders type II~III calcaneal fractures

摘要:

[目的] 介绍关节镜直视下 Sanders II~III 跟骨骨折复位内固定的手术技术和初步临床结果。[方法] 2019 年 2 月— 2021 年 1 月用本方法治疗 Sanders II~III 跟骨骨折患者 28 例。在跟骨结节及距骨颈处置入牵引针，用牵开器内外侧牵开，恢复跟骨的长度，无内外翻。关节镜入路为后外侧口入路及外侧口入路，直视下清除碎骨块、血肿，闭合撬拨复位跟骨后关节面， 恢复 Bohler 角、Gissane 角及跟骨高度，克氏针临时固定；将复位宽度的钢板置于足内外侧，用大力复位钳自足两侧持续向中间加压，逐渐恢复宽度。复位良好后置入经皮空心螺钉完成内固定。[结果]所有患者均顺利完成手术，术中无神经、血管损伤等严重并发症，随访 （13.3±1.4） 个月。末次随访，足踝活动度及力线恢复良好，依据 AOASF 评估标准，临床结果优 18 足，良 8 足，可 2 足，优良率为 92.9%。[结论] 关节镜直视下微创复位内固定 Sanders II~III 跟骨骨折，复位精准，术后并发症少，临床疗效满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopy-assisted reduction and per- cutaneous cannulated screw fixation for Sanders type II~III calcaneal fractures. [Methods] From February 2019 to January 2021, 28 pa- tients received abovementioned surgical procedures for Sanders type II~III calcaneal fractures. After pins were inserted into the calcaneal tubercles and the neck of the talus, distraction force was applied by a retractor to restore the length of the calcaneus, and facilitated subtalar arthroscopic procedures by the posterolateral and the lateral portals. The hematoma was removed, while the bone fragments were reduced under direct arthroscopic vision on the posterior articular surface. The calcaneal body fracture was reduced by closed prying to resume Bohler angle, Gissane angle and the height of the calcaneal bone, while the width was restored gradually by continuous pressure applied on the medial and lateral sides with vigorous reduction forceps over plates. Subsequently, percutaneous cannulated screws were placed to fin- ish the internal fixation in proper fracture reduction position. [Results] All the patients were successfully operated on without neurovascular injury and other serious complications, and followed up for (13.3±1.4) months on a mean. At the latest follow-up, the foot and ankle motion and alignment recovered well. According to the AOASF evaluation criteria, the clinical results were excellent in 18 feet, good in 8 feet and fair in 2 feet, with an excellent and good rate of 92.9%. [Conclusion] The arthroscopy-assisted reduction and percutaneous cannulated screw fixation for Sanders type II~III calcaneal fractures do achieve accurate reduction with fewer postoperative complications, and satisfac- tory clinical efficacy.