经皮撬拨复位内固定联合替代骨填充治疗跟骨关节内骨折.DOCVIP

临床医学论文-经皮撬拨复位内固定联合替代骨填充治疗跟骨关节内骨折 ??????????? 作者：倪明，梅炯，俞秀茂，王家骐，李山珠，祝晓忠 【摘要】? ［目的］介绍应用经皮撬拨复位内固定联合可注射人工替代骨填充治疗跟骨骨折的经验和技术要点。［方法］2004年4月～2006年4月，作者采用经皮撬拨复位空心螺钉固定联合可注射型高黏度人工替代骨填充方法，对15例16侧跟骨骨折进行治疗，男13例14侧，女2例2侧；年龄24～61岁，平均36.6岁。术前均摄跟骨侧位、轴位及足斜位X线片，并行CT三维重建检查。骨折按Sanders分型：Ⅱ型14侧（Ⅱa型3侧，Ⅱb型3侧，Ⅱc 8侧），Sanders Ⅲac型2侧。术中通过斯氏针垂直穿过跟骨结节牵引恢复跟骨长度，再沿跟骨外侧骨折线做0.5 cm切口，用弯组织剪向后上方撬拨复位后关节面。根据骨折类型，选择不同规格的空心松质骨螺钉固定骨折块。最后经切口注入人工替代骨填充跟骨内缺损。［结果］所有患者获得12～34个月（平均18.4个月）随访。术后均未发生切口感染、螺钉断裂及跟骨内翻等并发症。术后平均骨折愈合时间为10周。按美国足踝外科协会(AOFAS)后足评分系统，优12例，良4例，优良率100％。X线片检查示Bhler角、Gissane角、跟骨外形基本恢复正常。［结论］经皮撬拨复位内固定联合可注射人工替代骨填充适用于治疗Sanders Ⅱ、Ⅲ型跟骨骨折，具有操作简单、并发症少和临床疗效好等优点。 【关键词】? 跟骨； 经皮复位； 骨折内固定术； 人工骨 ??? Abstract：［Objective］To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. ??? ［Method］Percutaneous reduction and internal fixtion combined with bone graft was performed from April 2004 to April 2006 on 15 cases(16 sides) with intra-articular calcaneal fractures including 13 males (14 feet)and 2 females(2 feet)，with average age of? 36.6 years(24～61 years).All patients underwent radiography including lateral and? axial views for calcaneus,oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification，there were 12 feet of type Ⅱ(three type Ⅱa,three type Ⅱb and eight type Ⅱc)and 2 feet of type Ⅲac. The length of caicaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures.Then bone graft was injected to fill the defect of calcaneus through lateral incision. ??? ［Result］All patients were followed up for an average of 18.4 months (ranged,12 to 34 months).No complication such as wound infection，screw breakage