跟骨左腿髓内钉内固定

累及后脊柱面的跟颅左腿需选用手术病人已经定下认同，传统外侧“L”型不断扩大入路孔洞做手术孔洞心肌梗死较多，随着新科技的持续发展，现已持续发展出经胫颅窦入路、脊柱镜基本功能登位等新科技。

选择跟颅内松质颅结构设计，并避免对颅膜及骨骼血运造成损坏，有学者创造性选用髓内铁钉病人跟颅左腿，并来作了新作病可有统计数据，获取很差的治果。

一、Introduction

由于继发的距下脊柱原发性和后躯的特征叠加，反向的跟颅脊柱内左腿非手术病人通常与不良结尾就其。因此，有人认为只有对脊柱面和跟颅的大小进行病理学家学重修才能获得更好的仍然功效，大多数外科医生现在都提议外科病人。

在很长一段时间内，病人跟颅脊柱内左腿的金常规是通过不断扩大外侧入路进行切开登位内单独。然而，这种分析方法常会与疤痕愈合心肌梗死(5.8%-43%)就其，包括血肿、疤痕浅表发炎、浅表和深部疤痕传染。为了降更高这些风险，在从前几年内，电子式新科技给予了很好的持续发展，包括经皮螺栓单独、经胫颅窦入路、依赖于敌和脊柱镜基本功能单独。经胫颅窦入路可直接操纵脊柱登位，无需广泛应用的骨骼病理学家，并混合经皮内单独，使骨骼心肌梗死发生率高于。在这项研究工作中，我们旨在分析经胫颅窦入路经皮螺栓单独反向的跟颅脊柱内左腿的。

（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

分析经胫颅窦入路交锁髓内铁钉病人反向的跟颅脊柱内左腿的。（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可有（男48 女16）74躯。

（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

在所有病可有中，后脊柱面通过胫颅窦入路，选用1-2枚螺栓单独。在所有脊柱的颅块单独后，选用经皮交锁髓内铁钉单独，6枚意味著铁钉。

（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°忽略到术后28.6°，脊柱面台阶由术前5.4mm忽略到术后0.6mm，术后影像学评级平均值2.9。随后皮肤边缘发炎3可有（4%），浅表传染1可有（1.3%）。经过1年随访，平均值AOFAS评级90.2分，平均值Maryland后躯评级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 Price Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. ）

六、Conclusions

在后脊柱面通过螺栓获得登位后，交锁髓内铁钉可以作为反向跟颅脊柱内左腿具有很差的稳定性和更高心肌梗死的一种可选择的分析方法。

（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. ）