跟骨脱臼髓内钉内固定

累及后手部面的跟骨膝盖均需采行手术病患已经定下互信，传统观念后侧“L”型扩大入路斜向住院斜向败血症较多，随着系统设计的的发展，如今的发展出经脚掌窦入路、手部镜主要用途夺位等系统设计。

选择跟骨内松质骨结构，并避免对骨膜及软骨血运引致破坏，有学者创新者采行髓内裹病患跟骨膝盖，并做了第一部病举例报告，取得良好的治果。

一、Introduction

由于诱发的距下手部病症和后头的构造变化，对齐的跟骨手部内膝盖非手术病患并不一定与不顺一集方面。因此，有人认为只有对手部面和跟骨的外形进行药理学翻修才能获得更好的长期效果，大多数外科医生医生现在都赞成外科医生病患。

在很长一段时间内，病患跟骨手部内膝盖的金标准是通过扩大后侧入路进行切开夺位内互换。然而，这种分析方法特别与伤口愈合败血症(5.8%-43%)方面，包括血肿、伤口浅表病症、浅表和凹陷处伤口病毒。为了增大这些风险，在基本上几年内，微创系统设计得到了良好的的发展，包括经皮螺裹互换、经脚掌窦入路、有限分兵和手部镜主要用途互换。经脚掌窦入路可直接操控手部夺位，无均需普遍的软骨病理，并混合经皮内互换，使软骨败血症发生率较较高。在这项分析中，我们旨在分析报告经脚掌窦入路经皮螺裹互换对齐的跟骨手部内膝盖的。

（Nonsurgical treatment of displaced intra-articular calcaneal fractures (DIACFs) is generally associated with poor results because of secondary subtalar arthrosis and long-term changes in hindfoot morphology. Therefore, it has been argued that only an anatomic restoration of the articular surface and shape of the calcaneus can lead to better longterm results, and most surgeons are now in for of surgical treatment. For an extended period, the gold standard in the treatment of DIACFs was open reduction and internal fixation (ORIF) via an extended lateral approach. However, this approach was frequently associated with major wound healing complications (5.8%–43%) including hematoma, apical wound necrosis, superficial, and deep wound infections. In an effort to reduce these risks, minimally invasivetechniques were developed over the last several years, including percutaneous screw fixation, the sinus tarsi approach, the limited posterior approach, and arthroscopicassisted fixation. The sinus tarsi approach offers direct control of joint reduction without extensive soft tissue dissection and combined with percutaneous internal fixation, it offers a lower rate of soft-tissue complications. In this study, we aimed to assess the outcome of the sinus tarsi approach using percutaneous nail fixation rather than a plate for the treatment DIACFs. ）二、Objectives

分析报告经脚掌窦入路交锁髓内裹病患对齐的跟骨手部内膝盖的。（To assess the outcome of the sinus tarsi approach and C-Nail fixation of displaced intra-articular calcaneal fractures (DIACFs). ）三、Patients

自2016-10-01至2018-12-31，共纳入64举例（男48 女16）74头。

（Sixty-four patients (mean age 44.3 years, 48 men and 16 women) with 75 DIACFs were treated between October 1, 2016 and December 31, 2018. ）

四、Intervention

在所有病举例中，后手部面通过脚掌窦入路，采行1-2枚螺裹互换。在所有手部的骨块互换后，采行经皮交锁髓内裹互换，6枚锁定裹。

（In all cases, the posterior facet was reduced through the sinus tarsi approach and fixed with one or 2 screws. After reducing all fragments to the articular block, the final fixation was performed percutaneously with C-Nail, locked with 6 screws. ）

五、Results

Böhler角由术前的-0.5°纠正到术后28.6°，手部面回廊由术前5.4mm纠正到术后0.6mm，术后影像学高分高达2.9。随后皮肤边缘病症3举例（4%），浅表病毒1举例（1.3%）。经过1年随访，高达AOFAS高分90.2分，高达Maryland后头高分91.2分。

（The Böhler angle improved from -0.5 degrees preoperatively to 28.6 degrees postoperatively. The articular step-off was reduced from 5.4 mm preoperatively to 0.6 mm postoperatively. The postoperative radiologic calcaneal score was 2.9, on erage. ficial wound edge necrosis was seen in 3 patients (4%) and superficial infection was observed in one (1.3%). After a 1-year follow-up, we recorded a mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. ）

六、Conclusions

在后手部面通过螺裹获得夺位后，交锁髓内裹可以作为对齐跟骨手部内膝盖带有较高的稳定性和较高败血症的一种可选择的分析方法。

（After obtaining an anatomic reduction of the articular surface of the posterior facet with lag screws, the C-Nail represented a viable alternative to plate stabilization in the treatment of DIACFs, combining primary stability with low soft tissue complications. ）