标题：足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗跟骨闭合性骨折

      作者：杜俊伟，何鹏，马拓，王斌，石海浪    西电集团医院骨科，陕西 西安 710077

      卷次： 2020年31卷23期

      【摘要】 目的 探究跟骨闭合性骨折患者足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗的临床效果。方法 选择2016年3月至2019年3月西电集团医院骨科收治的22例(27足)跟骨闭合性骨折患者进行研究，采取足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗。治疗后，观察患者的跟骨宽度、长度、高度、B?hler角、Gissane角的改善情况，根据Maryland足功能评分系统评价患者的足功能恢复情况。结果 22例(27足)患者术后伤口中仅有1例1足在足跟后方切口延迟愈合，经换药处理后愈合；所有患者均在术后4~6个月时切口愈合，未有骨髓炎、切口边缘坏死、跟骨畸形等并发症发生；术后患者的跟骨宽度、长度、高度、B?hler角度和Gissane角度分别为(44.82±5.21) mm、(80.62±4.23) mm、(44.45±3.12) mm、(25.01±5.13)°、(103.82±8.64)°，较术前的(50.52±6.34) mm、(76.47±4.56) mm、(40.02±4.52) mm、(12.12±3.82)°、(117.03±10.32)°明显改善，差异均有统计学意义(P<0.05)；根据Maryland足功能评分系统评价，优21足，良4足，可2足，优良率为92.59%。结论 跟骨闭合性骨折患者采用足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗效果较好，患者恢复速度快，术后并发症少，值得临床上推广应用。
      【关键词】 足跟后方；接骨板内固定；跗骨窦；小切口；跟骨闭合性骨折；疗效；并发症
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2020）23—3068—03

Effect of small incision open reduction and internal fixation with bone plate via posterior heel combined withtarsal sinus approach in the treatment of closed fracture of calcaneus.
DU Jun-wei, HE Peng, MA Tuo, WANG Bin,SHI Hai-lang. Department of Orthopedics, Xidian Group Hospital, Xi'an 710077, Shaanxi, CHINA
【Abstract】 Objective To explore the clinical effect of small incision open reduction and internal fixationwith bone plate via posterior heel combined with tarsal sinus approach in patients with closed fracture of calcaneus.Methods Twenty-two patients (27 feet) with closed fracture of calcaneus admitted to the Department of Orthopedics,Xidian Group Hospital from March 2016 to March 2019 were selected for the study, which were treated with small inci-sion open reduction and internal fixation with bone plate via posterior heel combined with tarsal sinus approach. Aftertreatment, the improvement in the width, length, height, B?hler angle, Gissane angle of calcaneus were observed, and therecovery of foot function was evaluated according to the Maryland Foot Function Score System. Results Among the 22patients (27 feet), only 1 case (1 foot) had delayed healing of the incision in posterior heel, which healed after dressingchange. All patients had the incision healed in 4 to 6 months after surgery, without complications such as osteomyelitis, ne-crosis of the margin of the incision, and calcaneus deformity. The postoperative calcaneal width, length, height, B?hler an-gle, and Gissane angle were (44.82±5.21) mm, (80.62±4.23) mm, (44.45±3.12) mm, (25.01±5.13)°, (103.82±8.64)°, whichwere significantly improved as compared with (50.52±6.34) mm, (76.47±4.56) mm, (40.02±4.52) mm, (12.12±3.82)° ,(117.03±10.32)° before operation (P<0.05). According to the Maryland Foot Function Score System, the function was ex-cellent in 21 feet, good in 4 feet, fair in 2 feet, and the excellent and good rate was 92.59%. Conclusion Patients withclosed fracture of calcaneus treated with small incision open reduction and internal fixation with bone plate via posteriorheel combined with tarsal sinus approach have good therapeutic effect, with quick recovery and few complications, whichis worthy of clinical application.
      【Key words】 Posterior heel; Internal fixation with bone plate; Sinus tarsi; Small incision; Closed fracture of cal-caneus; Efficacy; Complications