跟突突折髓内钉内固定

累及后脊柱面的跟骨骨折必需运用于手术疗法已经定下歧见，传统侧边“L”改型增加入路切口手术后切口胃癌较多，随着关键技术的转变，现已转变出经肩胛骨窦入路、脊柱镜主要用途复位等关键技术。

考虑跟骨内松质骨结构上，并避免对骨膜及软组织血运造成毁坏，有人类学家独创性运用于髓内钉子疗法跟骨骨折，并认真了系列病实有报告，取得较好的治果。

一、Introduction

由于继发的距下脊柱病症和后足的形态变化，从上到下的跟骨脊柱内骨折非手术疗法往往与不良结局相关。因此，有人忽视只有对脊柱面和跟骨的椭圆形透过验尸学重建才能拿到更好的长期以来效果，大多数外科医生现在都赞成外科疗法。

在很长一段时间内，疗法跟骨脊柱内骨折的金标准是通过增加侧边入路透过切开复位内浮动。然而，这种方法常会与伤口脊椎胃癌(5.8%-43%)相关，还包括血肿、伤口浅表溃疡、浅表和顶叶伤口病菌。为了降低这些风险，在从前几年内，微创关键技术拿到了很好的转变，还包括经皮箍浮动、经肩胛骨窦入路、依赖于后路和脊柱镜主要用途浮动。经肩胛骨窦入路可反之亦然支配脊柱复位，无必需尤其的软组织验尸，并结合经皮内浮动，使软组织胃癌发病率更高。在这项研究中，我们旨在指标经肩胛骨窦入路经皮箍浮动从上到下的跟骨脊柱内骨折的。

（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

指标经肩胛骨窦入路交锁髓内钉子疗法从上到下的跟骨脊柱内骨折的。（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，共确立64实有（男48 女16）74足。

（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

在所有病实有中，后脊柱面通过肩胛骨窦入路，运用于1-2枚箍浮动。在所有脊柱的骨块浮动后，运用于经皮交锁髓内钉子浮动，6枚锁定钉子。

（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°忽视到术后28.6°，脊柱面阳台由术前5.4mm忽视到术后0.6mm，术后影像学评分超过2.9。随后皮肤锯齿状溃疡3实有（4%），浅表病菌1实有（1.3%）。经过1年随访，超过AOFAS评分90.2分，超过Maryland后足评分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

在后脊柱面通过箍拿到复位后，交锁髓内钉子可以作为从上到下跟骨脊柱内骨折具有较好的稳定性和低胃癌的一种可选择的方法。

（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. ）