经皮克氏针撬拨复位内固定治疗儿童跟骨关节内骨折的疗效分析

摘要

Objective: To introduce and evaluate the clinical effects of percutaneous reduction and Kirschner pin fixation for the treatment of intraarticular fractures of the calcaneus in children. Methods: From March 2001 to February 2009,12 patients with intraarticular calcaneal fractures were treated by percutaneous reduction and Kirschner pin fixation(13 feet). There were 8 males and 4 females,ranging in age from 3 to 14, with an average of 8.7 years. According to Kssex-Lopresti classification, among 5 feet were tongue fractures and 8 feet were compressed fractures. According to Sanders classification, 9 feet were type II and 4 feet were type 111. The Bohler angle and Gissane angle of the calcaneus were obtained before and after operation. All patients were evaluated according to Maryland Foot Score. Results. All the patients were followed up for 16-71 months (means 35.9 months),and all the incisions were healed without complications and infection. The preoperative X-ray film showed that Bohler angle was (19.7±5.3)°,Gissane angle was (137.3±7.5)°. The postoperative X-ray film demonstrated that Bohler angle was (32.6±3.7)°,Gissane angle was (125.4±2.9)°. There was a significant difference between preoperative and postoperative (P < 0.01). The average Maryland score was 96.3±2.4 (range,92 to 100 points). Conclusion: Percutaneous reduction and Kirschner pin fixation is an effective minimally invasive way to treat intraarticular fractures of the calcaneus in children,it has many advantages such as minimal invasion,reliable fixation and satisfactory effects.%目的:介绍经皮克氏针撬拨复位内固定治疗儿童跟骨骨折,评估该方法的临床疗效.方法:2001年3月至2009年2月,采用经皮克氏针撬拨复位内固定治疗儿童跟骨关节内骨折12例(13足),其中男8例,女4例;年龄3～14岁,平均8.7岁.骨折按Essex-Lopresti分型:舌型骨折5足,压缩型骨折8足.按Sanders分型:Ⅱ型9足,Ⅲ型4足.手术前后摄X线片,比较跟骨Bohler角和Gissane角的恢复情况,疗效评价采用Maryland足部评分系统.结果:所有患者均获随访,时间16～71个月,平均35.9个月.骨折均获愈合,无创口愈合不良、坏死感染发生.术前B(o)hler角为(19.7±5.3 )°,术后为(32.6±3.7)°;术前Gissane角为(137.3±7.5)°,术后为(125.4±2.9)°,上述影像学测量结果与术前比较差异均有统计学意义(P<0.01 ).Maryland评分92～100分,平均(96.3±2.4)分.结论:经皮克氏针撬拨复位内固定术,软组织损伤小、固定可靠、疗效满意,是儿童跟骨关节内骨折有效的微创治疗方法.