跟骨脚踝髓内钉内固定

累及后肌腱面的跟肩胛骨脱臼需使用手术治疗法已经达成协议一致意见，宗教性后侧“L”改进型扩展到入路斜向中风斜向肝硬化相当多，随着核心技术的持续发展，都已持续发展出经股肩胛骨窦入路、肌腱镜除此以外篡位等核心技术。

考虑跟肩胛骨内松质肩胛骨结构，并避开对肩胛骨膜及脊椎血运造成破坏，有学者创新性使用髓内铁钉治疗法跟肩胛骨脱臼，并要用了第四部病可有报告，取得良好的治果。

一、Introduction

由于继发的距下肌腱炎症和后躯的其本质叠加，重复的跟肩胛骨肌腱内脱臼非手术治疗法通常与不良结局涉及。因此，有人看来只有对肌腱面和跟肩胛骨的大小透过解剖学重建才能获得更好的长期缺点，大多数儿科医生现在都赞成儿科治疗法。

在很长一段时间内，治疗法跟肩胛骨肌腱内脱臼的金新标准是通过扩展到后侧入路透过切开篡位内浮动。然而，这种法则不时与外伤下颚肝硬化(5.8%-43%)涉及，仅限于血肿、外伤浅表炎症、浅表和裂隙外伤染病。为了降高于这些风险，在过去几年内，电子式核心技术得到了极佳的持续发展，仅限于经皮螺铁钉浮动、经股肩胛骨窦入路、极少后路和肌腱镜除此以外浮动。经股肩胛骨窦入路可直接控制肌腱篡位，无需广泛的脊椎解剖，并转化经皮内浮动，使脊椎肝硬化发生率较高于。在这项研究中，我们旨在评量经股肩胛骨窦入路经皮螺铁钉浮动重复的跟肩胛骨肌腱内脱臼的。

（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

评量经股肩胛骨窦入路交锁髓内铁钉治疗法重复的跟肩胛骨肌腱内脱臼的。（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，共设为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，后肌腱面通过股肩胛骨窦入路，使用1-2枚螺铁钉浮动。在所有肌腱的肩胛骨块浮动后，使用经皮交锁髓内铁钉浮动，6枚锁定铁钉。

（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°纠正到术后28.6°，肌腱面高台由术前5.4mm纠正到术后0.6mm，术后CT打分平均值2.9。随后表皮边缘炎症3可有（4%），浅表染病1可有（1.3%）。经过1年随访，平均值AOFAS打分90.2分，平均值Maryland后躯打分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 Andrew Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. ）

六、Conclusions

在后肌腱面通过螺铁钉获得篡位后，交锁髓内铁钉可以作为重复跟肩胛骨肌腱内脱臼具备较佳的准确度和高于肝硬化的一种可选择的法则。

（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. ）