跟骨骨折临时外固定牵开闭合复位空心钉内固定

Closed reduction and percutaneous cannulated screw fixation under temporary distraction by external frames for calcaneal fractures

摘要:

［目的］ 介绍临时外固定牵开下 SandersⅡ、Ⅲ型跟骨骨折闭合复位空心钉内固定的手木技术和初步临床效果。［方法］2019 年 10 月—2020 年 12 月采取双侧牵开经皮闭合复位空心螺钉内固定治疗跟骨骨折 16 例，患者取健侧卧位，分别于跟骨结节、距骨头贯穿置入 1 枚斯氏针，内、外侧各连接 1 个跟骨牵开器，同时牵开，矫正内翻畸形，恢复后关节面平整及跟骨形态，尔后经皮空心螺钉固定跟骨骨折。［结果］所有患者均顺利完成手术，术中无血管、神经损伤等严重并发症，手术时间 （98.00±14.76） min，术后未出现切口不愈合或延迟愈合、浅层及深部组织感染等情况。术后 Gissane 角、B?hler 角、跟骨长度、跟骨宽度及高度恢复良好，优良率 93.75%。［结论］ 双侧牵开经皮闭合复位空心钉内固定治疗 SandersⅡ~Ⅲ型跟骨骨折， 术后切口并发症少，术前等待时间短，治疗效果明显。

Abstract:

[Objective] To introduce the surgical technique and its preliminary outcomes of closed reduction and percutaneous cannu- lated screw fixation under temporary distraction by external frames for Sanders type II and III calcaneal fractures. [Methods] From October 2019 to December 2020, 16 patients received closed reduction and percutaneous cannulated screw fixation for Sanders type II and III calca- neal fractures. After the patients were placed in the healthy lateral decubitus position, a Schanze pin was inserted transversely through the calcaneus tuberosity and the talus respectively. A pair of external frames was attached with the pins on the medial and lateral sides. Distrac- tion was applied by the frames to correct varus and shorten deformities, and restore smooth articular surface and calcaneal shape. Finally, percutaneous cannulated screws were placed to fix the calcaneal fractures. [Results] All patients had surgical procedures performed suc- cessfully with no serious complications, such as vascular and nerve injury, whereas with operation time of (98.00±14.76) min. All patients got incision healing well without non- healing, delayed healing, or superficial and deep tissue infection. All patients had Gissane angle, Bohler angle, calcaneus length, calcaneus width and height recovered well on radiographs postoperatively, with the excellent and good rate of 93.75%. [Conclusion] The closed reduction and percutaneous cannulated screw fixation under bilateral distraction for calcaneal frac- tures has benefits of fewer postoperative incision complications, shortening preoperative waiting time, and achieve sound preliminary clini- cal outcomes.