摘要
[目的]研究超声辅助定位载距突螺钉位置在跗骨窦入路开放复位内固定跟骨骨折的意义。[方法]2015年2月~2018年5月,47例(52足)跟骨骨折患者纳入本研究,采用随机数字表法分为两组。超声定位组24例(27足),术前通过超声确定载距突的体表定位点,术中用导向器自外侧壁钢板处置入载距突螺钉;常规组23例(25足)采取常规术中C型臂透视定位打入载距突螺钉。比较两组临床与影像结果。[结果]两组患者均顺利手术,超声定位组手术时间、术中透视次数显著优于常规组(P<0.05)。随访时间12~18个月,随着随访时间延长,两组患者AOFAS评分均显著增加(P<0.05)。术前和术后1个月时,两组间AOFAS评分差异无统计学意义(P>0.05),术后12个月随访,超声定位组显著优于常规组(P<0.05)。影像显示术后两组患者骨折均达到复位标准,超声定位组无载距突螺钉穿出,常规组4枚载距突螺钉穿出。术后两组患者Bohler角和Gissane角均较术前显著增加(P<0.05);术后12个月随访时,超声定位组的Bohler角和Gissane角显著优于常规组(P<0.05)。[结论]术前超声定位载距突不仅可以更精确的置入载距突螺钉,而且手术更加微创、安全。
[Objective]To study the role of ultrasound-assisted localization for lag screw through sustentaculum tali in open reduction and internal fixation(ORIF)on clinical outcomes of calcaneus fractures by tarsal sinus approach.[Methods]From February 2015 to May 2018,47 patients(52 feet)with calcaneal fractures met the inclusion criteria were randomly divided into two groups.Of them,24 patients(27 feet)received perioperative ultrasound location for insertion of lag screw through sustentaculum tali in ORIF(the ultrasound group),while the remaining 23 patients(25 feet)had the lag screw inserted by intraoperative fluoroscopy in the ORIF(the conventional group).The clinical and radiographic documentations were compared between the two groups.[Results]All patients in both groups got successful operations.The ultrasound group proved significantly superior to the conventional group regarding to operation time and fluoroscopy frequency(P<0.05).As time went during the follow-up period lasted for 12~18 months,the AOFAS sores significantly increased in both groups(P<0.05).The ultrasound group was significantly superior to the conventional group in AOFAS score at the latest follow-up(P<0.05).With regard to radiographic assessment,all patients in the two groups got satisfactory fracture reduction,with cortical penetration of sustentaculum tali in none of the ultrasound group,whereas 4 cases of the conventional group.Both the Bohler angle and Gissane angle significantly increased in the two groups after operation compared with those before operation(P<0.05).The ultrasound group proved significantly superior to the conventional group in aforesaid imaging items at the latest follow-up(P<0.05).[Conclusion]This preoperative ultrasound localization for lag screw through sustentaculum tali not only improves accuracy of screw placement,but also minimizes iatrogenic trauma,enhances safety and outcomes of ORIF for calcaneus fractures.
作者
孙勃
刘士波
薛鑫鑫
高云峰
付世杰
王培
SUN Bo;LIU Shi-bo;XUE Xin-xin;GAO Yun-feng;FU Shi-jie;WANG Pei(Department of Hand and Foot Surgery,Affiliated Hospital,Chengde Medical College,Chengde 067000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第14期1269-1273,共5页
Orthopedic Journal of China
基金
河北省医学科学研究重点课题计划项目(编号:20150017)。
关键词
跟骨骨折
载距突
开放复位内固定
超声定位
calcaneus fracture
sustentaculum tali
open reduction and internal fixation
ultrasound location
