Miyamura Satoshi, Ota Haruka, Okamoto Michio, Namba Jiro, Yamamoto Koji
Orthopaedist, Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
Orthopaedist, Department of Orthopaedic Surgery, Itami City Hospital, Hyogo, Japan.
J Foot Ankle Surg. 2016 Jan-Feb;55(1):157-60. doi: 10.1053/j.jfas.2015.08.008. Epub 2015 Oct 2.
Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation.
跟骨撕脱骨折相对少见，最常见于老年或骨质疏松患者。尚未开发出一种能避免固定后撕脱骨块移位的手术方法。我们报告了3例患者（1例73岁男性、1例85岁男性和1例81岁女性）的病例，他们接受了使用钛丝和空心松质骨螺钉的切开复位内固定治疗。采用后入路，经垂直中线切口进行手术。骨折用2枚螺钉固定，然后将钛丝穿过空心螺钉的孔。在足底外侧增加一个小切口以便钛丝穿出和返回。2例患者的钛丝结在近端跟腱滑囊内弯曲，1例患者的钛丝结朝向足底侧以避免刺激。所有3例患者均实现了骨愈合，骨块无再次移位。踝关节功能恢复正常，患者日常生活活动几乎恢复到原来水平。尽管需要额外的足底切口，但这种手术技术提供了坚强的内固定。
