[1]彭亮,刘双,魏国华,等.距下关节镜辅助下经皮撬拨复位内固定治疗合并糖尿病的跟骨骨折[J].中医正骨,2021,33(03):64-67.
　PENG Liang,LIU Shuang,WEI Guohua,et al.Percutaneous leverage reduction and internal fixation assisted by subtalar arthroscopy for treatment of calcaneal fractures combined with diabetes[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(03):64-67.
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距下关节镜辅助下经皮撬拨复位内固定治疗合并糖尿病的跟骨骨折()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年03期
页码:
64-67
栏目:
临床报道
出版日期:
2021-03-20

文章信息/Info

Title:
Percutaneous leverage reduction and internal fixation assisted by subtalar arthroscopy for treatment of calcaneal fractures combined with diabetes
作者:
彭亮; 刘双; 魏国华; 巫宗德; 刘亮; 张强; 刘然
(1.四川省骨科医院,四川 成都 610041; 2.辽宁省体育事业发展中心康复医疗中心,辽宁 沈阳 110179)
Author(s):
PENG Liang; LIU Shuang; WEI Guohua; WU Zongde; LIU Liang; ZHANG Qiang; LIU Ran
关键词:
骨折; 闭合性;  跟骨;  关节镜检查;  糖尿病;  撬拨复位;  骨折固定术; 内
摘要:
目的:探讨距下关节镜辅助下经皮撬拨复位内固定治疗合并糖尿病的跟骨骨折的临床疗效和安全性。方法:2016年3月至2019年7月收治22例闭合性跟骨骨折患者。男14例,女8例。年龄36～65岁,中位数48.5岁。根据Essex-Lopresti分型,舌型骨折6例、关节压缩型骨折16例。根据Sanders分型,Ⅱ型14例(ⅡA型5例、ⅡB型7例、ⅡC型2例)、Ⅲ型8例(ⅢAC型4例、ⅢAB型3例、ⅢBC型1例)。所有患者均合并2型糖尿病,1例合并同侧闭塞性下肢动脉硬化,2例合并下肢周围神经病变。均采用距下关节镜辅助下经皮撬拨复位内固定治疗。在X线片上测量患者的跟骨高度、宽度、长度、B?ler角、Gissane角,采用Burwell-Charnley骨折复位放射学标准评定复位情况,采用美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分标准评定总体疗效。观察记录治疗及随访期间的并发症发生情况。结果:所有患者均获得随访,随访时间11～37个月,中位数13个月。术后3 d拍摄的X线片显示,患侧的跟骨长度、跟骨高度、B?ler角、Gissane角均较术前增大[(73.41±4.51)mm,(81.21±2.20)mm,t=2.121,P=0.031;(32.34±3.60)mm,(41.21±3.20)mm,t=1.945,P=0.021; 8.3°±2.1°,24.8°±3.2°,t=3.931,P=0.008; 91.1°±4.7°,112.2°±1.4°,t=2.224,P=0.040],跟骨宽度较术前减小[(44.25±2.50)mm,(34.21±2.10)mm,t=-3.112,P=0.011]。术后1周时,按照Burwell-Charnley骨折复位放射学标准评定,解剖复位16例(SandersⅡ型13例、Ⅲ型3例),复位一般5例(SandersⅡ型1例、Ⅲ型4例),复位差1例(SandersⅢ型); 复位评定为差的患者,随访期间未出现骨关节炎表现,未进行处理。末次随访时所有骨折均达到临床愈合标准; AOFAS踝与后足功能评分为(90.00±2.18)分; 20例糖化血红蛋白<7%,2例糖化血红蛋白>7%,但均无糖尿病足表现。所有手术切口均愈合,其中21例3周内甲级愈合,1例术后6周时乙级愈合。所有患者均未发生跟骨骨髓炎、跟腱挛缩、创伤性马蹄内翻足、踝关节僵硬等并发症。结论:采用距下关节镜辅助下经皮撬拨复位内固定治疗合并糖尿病的跟骨骨折,可实现骨折的精准复位和有效固定,术后关节功能恢复好,并发症少。

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备注/Memo

备注/Memo:
基金项目:四川省医学会骨科(尚安通)专项科研课题(2019SAT14)
通讯作者:刘双 E-mail:424120294@qq.com
更新日期/Last Update: 1900-01-01