Rammelt Stefan, Amlang Michael, Barthel Sven, Zwipp Hans
Department of Trauma and Reconstructive Surgery, University Hospital, Carl Gustav Carus, Dresden, Germany.
Injury. 2004 Sep;35 Suppl 2:SB55-63. doi: 10.1016/j.injury.2004.07.012.
Percutaneous reduction methods play an important role in the management of calcaneal fractures with severe soft tissue compromise, particularly open fractures, and they offer a treatment alternative in patients with local or systemic contraindication to open reduction. Percutaneous reduction by pin leverage (Westhues or Essex-Lopresti maneuver) followed by minimally invasive screw fixation is a treatment option that yields good to excellent results in tongue-type fractures with posterior facet displacement as a whole (Sanders-type IIC). This method can be applied to selected Sanders-type IIA or IIB fractures if the quality of joint reduction is controlled arthroscopically. Although some authors have expanded the use of percutaneous reduction by traction, leverage, and compression with subsequent K-wire or screw fixation with remarkable results, the uniform application of percutaneous methods to all intra-articular calcaneus fractures is critical. Inadequate joint reduction and redislocation of the fragments in highly unstable fractures may occur in a considerable percentage of cases. Prolonged transfixation of the subtalar and calcaneocuboid joints is strongly discouraged, because functional aftertreatment is an important part of the rehabilitation after calcaneal fractures.
经皮复位方法在严重软组织损伤的跟骨骨折治疗中，尤其是开放性骨折，起着重要作用，并且为存在局部或全身开放性复位禁忌证的患者提供了一种治疗选择。通过钢针撬拨（韦斯特休斯或埃塞克斯-洛普雷蒂手法）进行经皮复位，随后进行微创螺钉固定，对于整体后关节面移位的舌型骨折（桑德斯II C型）是一种能取得良好至极佳效果的治疗选择。如果通过关节镜控制关节复位质量，该方法可应用于选定的桑德斯II A型或II B型骨折。尽管一些作者扩大了经皮牵引、撬拨和加压复位并随后进行克氏针或螺钉固定的应用范围，且取得了显著效果，但将经皮方法统一应用于所有关节内跟骨骨折至关重要。在相当一部分病例中，高度不稳定骨折可能会出现关节复位不充分和骨折块再移位的情况。强烈不建议长时间固定距下关节和跟骰关节，因为功能后期治疗是跟骨骨折后康复的重要组成部分。
