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[1]吳世奇.跟骨骨折內(nèi)固定手術(shù)中跟骨前部螺釘?shù)闹冕敳呗匝芯縖J].中醫(yī)正骨,2021,33(05):19-23.
　WU Shiqi.Strategy for anterior calcaneus screws placement in surgery of internal fixation for calcaneus fractures:a radioanatomic study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(05):19-23.
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年05期
頁(yè)碼:
19-23
欄目:
臨床研究
出版日期:
2021-05-20

文章信息/Info

Title:
Strategy for anterior calcaneus screws placement in surgery of internal fixation for calcaneus fractures:a radioanatomic study
作者:
吳世奇
(濟(jì)寧市第一人民醫(yī)院,山東 濟(jì)寧 272000)
Author(s):
WU Shiqi
The First People’s Hospital of Jining,Jining 272000,Shandong,China
關(guān)鍵詞:
跟骨;  骨折固定術(shù); 內(nèi);  骨釘;  跟骰關(guān)節(jié);  載距突
Keywords:
calcaneus;  fracture fixation; internal;  bone nails;  calcaneocuboid joint;  sustentaculum tali
摘要:
目的:探討跟骨骨折內(nèi)固定手術(shù)中跟骨前部螺釘?shù)闹冕敳呗浴７椒?選擇40例單側(cè)跟骨骨折患者,男25例、女15例。選擇患者的健側(cè)跟骨CT影像進(jìn)行研究,在影像存儲(chǔ)與傳輸系統(tǒng)中測(cè)量跟骰關(guān)節(jié)及載距突的各項(xiàng)解剖參數(shù),包括跟骰關(guān)節(jié)橫徑、跟骰關(guān)節(jié)后斜角、載距突前后徑、載距突上斜角、載距突上下徑及載距突螺釘最大長(zhǎng)度。結(jié)果:男性的跟骰關(guān)節(jié)橫徑、載距突螺釘最大長(zhǎng)度均大于女性[跟骰關(guān)節(jié)橫徑:(22.40±1.86)mm,(19.97±1.80)mm,t=4.043,P=0.000; 載距突螺釘最大長(zhǎng)度:(52.45±3.99)mm,(44.81±2.18)mm,t=6.817,P=0.000]; 男性和女性的跟骰關(guān)節(jié)后斜角、載距突前后徑、載距突上斜角、載距突上下徑比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[跟骰關(guān)節(jié)后斜角:21.05°±4.42°,21.13°±3.52°,t=-0.060,P=0.952; 載距突前后徑:(17.85±2.41)mm,(16.49±1.88)mm,t=1.865,P=0.070; 載距突上斜角:33.49°±4.76°,35.09°±5.11°,t=-0.999,P=0.324; 載距突上下徑:(13.59±1.84)mm,(12.79±1.35)mm,t=1.464,P=0.151]。載距突基底部截面沿其軸線投射到跟骨外側(cè)壁的區(qū)域?yàn)楦乔安恐萌胼d距突螺釘?shù)睦硐雲(yún)^(qū)域,其前緣為跟骰關(guān)節(jié)面、下緣為跟骨外側(cè)壁下緣,面積≈載距突上下徑×載距突前后徑。結(jié)論:跟骨骨折內(nèi)固定手術(shù)中在跟骨前部置入螺釘時(shí),可通過(guò)在CT圖像中測(cè)量跟骰關(guān)節(jié)后斜角和跟骰關(guān)節(jié)橫徑確定進(jìn)釘角度和螺釘長(zhǎng)度; 自跟骨前部向載距突置入螺釘時(shí),進(jìn)釘點(diǎn)的理想?yún)^(qū)域?yàn)楦峭鈧?cè)壁前下方,進(jìn)釘時(shí)需同時(shí)在橫斷面和冠狀面調(diào)整進(jìn)釘角度,沿載距突軸線置入螺釘時(shí)所需螺釘最長(zhǎng); 男性患者的跟骨前部螺釘長(zhǎng)度和載距突螺釘最大長(zhǎng)度均大于女性患者。
Abstract:
Objective:To explore the strategy for anterior calcaneus screws placement in surgery of internal fixation for treatment of calcaneus fractures.Methods:Forty patients(25 males and 15 females)with unilateral calcaneus fractures were selected,and their CT imagings of the uninjured calcaneus were obtained for study.The anatomical parameters,including transverse diameter of calcaneocuboid joint,back bevel angle of calcaneocuboid joint,anteroposterior diameter(APD)of sustentaculum tali,upper bevel angle of sustentaculum tali,suprainferior diameter(SID)of sustentaculum tali and maximum length of screw required for optimal fixation of sustentaculum tali,were measured in picture archiving and communication system(PACS).Results:The transverse diameter of calcaneocuboid joint and maximum length of screw required for optimal fixation of sustentaculum tali were greater in male patients compared to female patients(22.40±1.86 vs 19.97±1.80 mm,t=4.043,P=0.000; 52.45±3.99 vs 44.81±2.18 mm,t=6.817,P=0.000).There was no statistical difference in back bevel angle of calcaneocuboid joint as well as APD,upper bevel angle and SID of sustentaculum tali between the male patients and the female patients(21.05±4.42 vs 21.13±3.52 degrees,t=-0.060,P=0.952; 17.85±2.41 vs 16.49±1.88 mm,t=1.865,P=0.070; 33.49±4.76 vs 35.09±5.11 degrees,t=-0.999,P=0.324; 13.59±1.84 vs 12.79±1.35 mm,t=1.464,P=0.151).The optimal region for implanting screws from the anterior part of calcaneus to sustentaculum tali was the area where the basal section of sustentaculum tali projected onto the lateral wall of calcaneus along its axis,and its leading edge was the calcaneocuboid joint surface and lower edge was the lower margin of calcaneal lateral wall,and its area was approximately equal to SID of sustentaculum tali multiplied by APD of sustentaculum tali.Conclusion:The angulation and length of the implanted screws can be confirmed by measuring the back bevel angle and transverse diameter of calcaneocuboid joint on CT imagings when implanting screws to the anterior part of calcaneus in surgery of internal fixation for treatment of calcaneus fractures.The optimal screw-insertion point is deemed as the anterior inferior part of calcaneal lateral wall,and the angulation of implanted screws should be adjusted in both transverse section and coronal plane when implanting screws to sustentaculum tali from the anterior part of calcaneus,and the screw with a maximum length is required when placement is performed along the axis of sustentaculum tali.The length of anterior calcaneus screw and the maximum length of screw required for optimal fixation of sustentaculum tali are greater in male patients comapred to female patients.

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