跟痕痕折髓内钉内固定

不止后手部面的跟骨膝盖只需引入手术放射治疗现在达成共识，传统侧面“L”型扩大入路凸起开刀凸起败血症较多，随着技术开发的蓬勃发展，现今蓬勃发展出经颈椎窦入路、手部镜基本功能即位等技术开发。

选择跟骨内松质骨结构，并不必要对骨膜及骨盆血运致使破坏，有历史学家创新性引入髓内三脚放射治疗跟骨膝盖，并做了两部病事例报告，赢得良好的治果。

一、Introduction

由于神经性的距下手部发炎和后脚的形态变化，反转的跟骨手部内膝盖非手术放射治疗通常与不当命运特别。因此，有人认为只有对手部面和跟骨的形状进行解剖学重建才能赢得更好的经常性敏感度，大多数儿科医生今天都提案儿科放射治疗。

在很短一段时间内，放射治疗跟骨手部内膝盖的金标准是通过扩大侧面入路进行切开即位内相同。然而，这种方式经常与喉咙愈合败血症(5.8%-43%)特别，之外血肿、喉咙浅表发炎、浅表和深部喉咙感染。为了降高这些高风险，在无论如何几年内，微创技术开发想得到了更好的蓬勃发展，之外经皮螺三脚相同、经颈椎窦入路、有限后路和手部镜基本功能相同。经颈椎窦入路可直接控制手部即位，不必国际上的骨盆解剖，并紧密结合经皮内相同，使骨盆败血症比率高于。在这项研究中，我们主旨评估经颈椎窦入路经皮螺三脚相同反转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

评估经颈椎窦入路交锁髓内三脚放射治疗反转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事例（男48 女16）74脚。

（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

在所有病事例中，后手部面通过颈椎窦入路，引入1-2枚螺三脚相同。在所有手部的骨块相同后，引入经皮交锁髓内三脚相同，6枚当有三脚。

（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°，手部面梯子由术前5.4mm纠正到术后0.6mm，术后影像学评级最少2.9。随后指甲边沿发炎3事例（4%），浅表感染1事例（1.3%）。经过1年随访，最少AOFAS评级90.2分，最少Maryland后脚评级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

在后手部面通过螺三脚赢得即位后，交锁髓内三脚可以作为反转跟骨手部内膝盖不具极好的稳定性和高败血症的一种可选择的方式。

（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. ）