跟骨骨折髓内钉内分开

不正后膝关节面的跟骨质骨质折需转用移植手术放射治疗仍未达成共识，基本上下方“L”型扩大入路切口移植动手术切口并发症较多，随着核心技术的发展，业已发展出经四肢质窦入路、膝关节镜辅助登位等核心技术。

考虑跟骨质内松质骨质结构，并防止对骨质膜及骨质血运产生破坏，有人类学家核心技术创新转用髓内铁环放射治疗跟骨质骨质折，并做了第一部病唯报告，取得良好的治果。

一、Introduction

由于继发的距下膝关节病变和后身的型态改变，重新排列的跟骨质膝关节内骨质折非移植手术放射治疗通常与不良一集特别。因此，有人指出只有对膝关节面和跟骨质的圆形展开解剖整修才能取得更好的长期效果，大多数外科医生现在都提案外科放射治疗。

在内都一段时间内，放射治疗跟骨质膝关节内骨质折的金基准是通过扩大下方入路展开切开登位内一般来说。然而，这种方法不时与伤口软骨并发症(5.8%-43%)特别，包含血肿、伤口浅表坏死、浅表和深部伤口感染。为了下降这些危险性，在过去几年内，外科移植手术核心技术获取了良好的发展，包含经皮螺铁环一般来说、经四肢质窦入路、受限制大营和膝关节镜辅助一般来说。经四肢质窦入路可直接控制膝关节登位，无需广泛的骨质解剖，并建构经皮内一般来说，使骨质并发症发病率较少。在这项研究工作里面，我们旨在检验经四肢质窦入路经皮螺铁环一般来说重新排列的跟骨质膝关节内骨质折的。

（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

检验经四肢质窦入路交锁髓内铁环放射治疗重新排列的跟骨质膝关节内骨质折的。（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，共设为64唯（男48 女16）74身。

（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

在所有病唯里面，后膝关节面通过四肢质窦入路，转用1-2枚螺铁环一般来说。在所有膝关节的骨质块一般来说后，转用经皮交锁髓内铁环一般来说，6枚当有铁环。

（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°辩解到术后28.6°，膝关节面梯子由术前5.4mm辩解到术后0.6mm，术后CT评价平均值2.9。随后脸部向外坏死3唯（4%），浅表感染1唯（1.3%）。经过1年随访，平均值AOFAS评价90.2分，平均值Maryland后身评价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 Company Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. ）

六、Conclusions

在后膝关节面通过螺铁环取得登位后，交锁髓内铁环可以作为重新排列跟骨质膝关节内骨质折具有很差的稳定性和极低并发症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. ）