摘要
目的 通过研究跟骨载距突本身及其与周围组织的解剖学关系来设计内固定的最佳位置和角度。方法 ①测量正常跟骨的以下指标：载距突的前倾角、跟骨后关节面前部的前倾角、跟骨中部最大宽度、载距突基底部厚度，②观察跟骨内部结构，③研究载距突及其周围结构解剖学，④观察跟骨中部螺钉模拟内固定及测量相关角度，⑤随访观察27例经外侧入路切开复位内固定治疗的跟骨关节内移位骨折患者的效果。结果 载距突的前倾角、跟骨后关节面前部的前倾角、跟骨中部最大宽度、载距突基底部最大及最小厚度分别是50°±5°、69°±5°、（41．75±1．76）mm、（12．14±1．60）mm、（4．81±1．07）mm；载距突中关节面下方的骨小梁结构致密，并且与跟骨后关节面下方的致密骨小梁相连续；载距突与走行于其内侧的肌腱血管关系密切；在冠状面上测量自后关节面到载距突的三个进针点打人克氏针的最佳进针方向分别是：最低点向上25°±5°、最高点向下3°±3°、中点向上13°±3°；根据以上测量值进行手术，无患者出现复位或内固定失败的情况，疗效按照美国足踝外科协会后足评分系统评分，优良率为88．9％。结论载距突是跟骨关节内移位骨折手术时螺钉置入的理想位置，应根据跟骨中部的横径选择螺钉的长度，根据载距突基底部的最小径选择螺钉的直径，根据载距突与后关节面的相互关系决定螺钉的进钉方向，可以获得满意的临床疗效。
Objective To study the anatomy and clinical application of sustentaculum talus for displaced intraarticular ealcaneal fractures. Methods The anterior tilt angles of the sustentaeulum talus and the anterior part of posterior calcaneal facet, the maximal width of the middle calcaneum and the maximal and minimal thicknesses of the sustentaculum talus base were measured in 40 pieces of adult calcaneal specimens. The intraarticular structures of normal caleaneum were observed, including anatomical relations of the sustentaculum talus. The internal screw fixation of middle calcaneum was simulated to measure the positions and angles of screws. Follow-ups were conducted in 27 patients with displaced intraarticular calcaueal fractures treated by ORIF through an extensile right-angled lateral incision. The accuracy of screw insertion and functional outcome were assessed. Results The anterior tilt angle of the sustentaculum talus is 50°± 5°, the anterior tilt angle of anterior part of posterior calcaneal facet is 69°±5°, the width of the middle calcaneum is （41.75±1.76） mm, and the maximal and minimal thicknesses of sustentaculum tali base are （12. 14±1.60） mm and （4.81±1.07） mm respectively. The compact structure of bone trabecula beneath the sustentaculum talus progresses to the inferior part of the posterior calcaneal facet. The sustentaculum talus is closely connected with the tendons and vessels running along medially. The best 3 positions for screw insertion measured on coronal plane from the posterior facet to the sustentaculum talus arc as follows： the lowest position is 25°＋ 5°, upwards, the highest point is 3°± 3° downwards and the middle position is 13°± 3°. The excellent and good rate of functional outcome was 88.9%. Conclusions ORIF through an extensile right-angled lateral incision is effective for displaced intraarticular calcaneal fractures. The sustentaculum talus is a good place for screw insertion. The length of screws can be determined by the width of the middle calcaneum. The diameter of the screws depends on the minimal thicknesses of sustentaculum tall base. The angles of insertion arc determined by the relations between the sustentaculum talus and the posterior facet.
出处
《中华创伤骨科杂志》
CAS
CSCD
2009年第2期129-132,共4页
Chinese Journal of Orthopaedic Trauma
关键词
跟骨
骨折
骨折固定术
内
解剖学
Calcaneus
Fracture
Fracture fixation, internal
Anatomy
