Schepers Tim, Vogels Lucas M M, Schipper Inger B, Patka Peter
Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Room H974, 3000 CA, Rotterdam, The Netherlands.
Oper Orthop Traumatol. 2008 Jun;20(2):168-75. doi: 10.1007/s00064-008-1239-5.
Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment and, secondly, to reduce infectious complications compared to open reduction and internal fixation (ORIF).
Sanders type II-IV displaced intraarticular calcaneal fractures.
Isolated centrally depressed fragment. Patients who are expected to be noncompliant.
Four distractors (Synthes) are positioned, two on each side of the foot, between the tuberosity of the calcaneus and talus and between the tuberosity and cuboid. A distracting force is given over all four distractors. A blunt drifter is then introduced from the plantar side to unlock and push up any remaining depressed parts of the subtalar joint surface of the calcaneus. The reduction is fixated with two or three screws inserted percutaneously.
Directly postoperatively, full active range of motion exercises of the ankle joint can start, with the foot elevated in the 1st postoperative week. Stitches are removed after 14 days. Implant removal is necessary in 50-60% of patients.
Between 1999 and 2004, 59 patients with 71 fractures were treated by percutaneous skeletal triangular distraction and percutaneous fixation. A total of 50 patients with 61 fractures and a minimum follow-up of 1 year were available for follow-up. According to the American Orthopaedic Foot and Ankle Society Hindfoot Score, 72% had a good to excellent result. A secondary subtalar arthrodesis was performed in five patients and planned in four (total 15%). Böhler's angle increased by about 20 degrees postoperatively. Sagittal motion was 90% and subtalar motion 70% compared to the healthy foot.
通过撑开进行经皮复位，随后经皮螺钉固定以恢复跟骨及距下后关节面的解剖结构。与保守治疗相比，该技术的目的是改善功能结局并降低创伤后继发性关节炎的发生率，其次，与切开复位内固定术（ORIF）相比，减少感染并发症。
Sanders II-IV型移位的关节内跟骨骨折。
孤立的中央凹陷骨折块。预期不配合的患者。
放置四个撑开器（Synthes），在足部两侧各两个，置于跟骨结节与距骨之间以及结节与骰骨之间。对所有四个撑开器施加撑开力。然后从足底侧插入一个钝性拨棒，以解锁并抬起跟骨距下关节面任何剩余的凹陷部分。经皮插入两枚或三枚螺钉固定复位。
术后即可直接开始踝关节的全范围主动活动锻炼，术后第1周抬高足部。14天后拆线。50-60%的患者需要取出植入物。
1999年至2004年期间，59例患者的71处骨折采用经皮骨骼三角撑开和经皮固定治疗。共有50例患者的61处骨折可供随访，最短随访1年。根据美国矫形足踝协会后足评分，72%的患者结果为良好至优秀。5例患者进行了二期距下关节融合术，4例计划进行（共15%）。术后Böhler角增加约20度。矢状面活动度为健侧足的90%，距下关节活动度为70%。
