郭宗慧　余霄　杨长春

[摘要] 目的 探討新型跟骨载距突螺钉导向器的解剖学设计及在跟骨关节内骨折中的准确性分析。 方法 ①采用20例成人新鲜及防腐足部标本为研究对象，对载距突进行解剖测量，设计生产载距突螺钉导向器；②回顾性分析2012年11月～2016年11月收治的60例（60足）跟骨关节内骨折患者临床资料：其中男37例，女13例，年龄19～67岁，平均41岁，将其分为A、B两组，各30例。两组患者均采用常规跟骨外侧“L”形切口，均采用载距突螺钉内固定；A组采用常规盲打；B组采用自制新型载距突螺钉导向器辅助下置入。比较两组患者的出血量、手术时间、术中透视次数、切口愈合时间及临床疗效，术后采用Maryland足评分进行疗效评价。 结果 B组患者术中出血量（42.77±10.57）mL，手术时间为（38.56±11.45）min，术中透视次数（3.67±1.45）次，愈合时间（12.28±1.16）周，且总优良率为93.33%，均明显优于A组（P<0.05）。 结论 新型载距突螺钉导向器符合解剖学标准；采用新型跟骨载距突螺钉导向器辅助固定，明显提高载距突螺钉置入的准确性，减少术中出血量、减少手术时间，避免了因术中多次透视对骨科医生的放射性伤害，值得临床推广。

[关键词] 跟骨；载距突；骨折；螺钉导向器；关节内

[中图分类号] R683.42 [文献标识码] A [文章编号] 1673-9701（2018）04-0020-05

[Abstract] Objective To investigate the anatomical design of new-type calcaneus sustentaculum tali screw guide and the accuracy analysis in intra-articular calcaneal fractures. Methods ①20 adult fresh and preserved foot specimens were used as the research object. The anatomical measurement of the sustentaculum tali was conducted， and the LGA screw guide was designed and produced. ②The clinical data of 60 patients（60 feet） with intra-articular calcaneal fractures admitted from November 2012 to November 2016 retrospectively analyzed. Among them there were 37 males and 13 females， aged 19-67 years（average 41 years old）. The patients were divided into group A and B， with 30 cases in each group. The two groups of patients were treated with conventional lateral calcaneal L-shaped incision， with internal fixation of sustentaculum tali screw. Group A received conventional blind implantation， while the screw of group B was implanted assisted by new self-made calcaneus sustentaculum tali screw guide. The bleeding volume， operation time， number of intraoperative fluoroscopy， incision healing time and clinical curative effect were compared between two groups. The Maryland foot score was used to evaluate the curative effect. Results The intraoperative bleeding（42.77±10.57） ml， operation time（38.56±11.45）min， number of intraoperative fluoroscopy（3.67±1.45）times and healing time（12.28±1.16）weeks， the total excellent and good rate 93.33% in group B were all significantly better than those in group A（P<0.05）. Conclusion The new-type sustentaculum tali screw guide meets the anatomic standards. The application of new-type sustentaculum tali screw guide in assisting fixation significantly improves the accuracy of sustentaculum tali screw placement， reduces the intraoperative blood loss and the operation time， and avoids radiological injury to orthopedic surgeons due to multiple intraoperative fluoroscopy， which is worth clinical promotion.

[Key words] Calcaneus； Sustentaculum tali； Fracture； Screw guide； Intra-articular

跟骨骨折占全身骨折的2%，跗骨骨折的60%，约75%为关节内骨折[1，2]。由于跟骨的皮质骨较薄，而松质骨相对较多的特点，发生骨折时距骨的垂直压力常造成跟骨塌陷压缩，特别是后关节面常呈粉碎性骨折[3]。如何把跟骨后关节面复位、良好固定、恢复跟骨Bohler角、Gissane角对于跟骨骨折治疗效果至关重要[4]。

载距突周围被韧带及肌腱限制，即使跟骨骨折时也很少发生移位，治疗跟骨关节内骨折时后关节面的螺钉固定提供了有力把持点，使固定达到最大的生物力学强度[5]。无论改良跟骨外侧“L”型切口还是跗骨窦切口，均可良好暴露外侧的后关节面，但对于内侧的载距突难以暴露，要想固定载距突均需自外向内进行盲打，这样势必会增加术中透视次数，增加因载距突螺钉的偏差引起不必要的手术风险[6，7]。……