跟骨脱臼髓内钉内固定

受累后肌腱面的跟颚骨颚小腿需有别于切除病人已经达成合计识，基本上外侧“L”HG扩充入路切开切除后切开败血症并不多，随着高效率的发展，现已发展出经颈椎窦入路、肌腱镜专门设计复位等高效率。

考虑跟颚骨内松质颚骨结构，并避免对颚骨膜及肌肉组织血运遭受毁损，有历史学家创新者有别于髓内头上病人跟颚骨颚小腿，并做了复刻版病由此可知报告，夺得良好的治果。

一、Introduction

由于继发的距下肌腱病变和后在手的形态发生变化，移位的跟颚骨肌腱内颚小腿非切除病人通常与不良结局系统性。因此，有人认为只有对肌腱面和跟颚骨的形状进行时鉴定学修缮才能获得更好的长期精准度，大多数外科医生从前都提议外科病人。

在很长一段时间内，病人跟颚骨肌腱内颚小腿的金规范是通过扩充外侧入路进行时切开复位内单独。然而，这种新方法经常与内脏愈合败血症(5.8%-43%)系统性，之外血肿、内脏浅表坏死、浅表和深部内脏接种。为了降更高这些风险，在从前几年内，医学影像高效率得到了很好的发展，之外经皮螺头上单独、经颈椎窦入路、有限后路和肌腱镜专门设计单独。经颈椎窦入路可单独控制肌腱复位，无需广泛的肌肉组织鉴定，并结合经皮内单独，使肌肉组织败血症发生率较更高。在这项研究中的，我们旨在分析报告经颈椎窦入路经皮螺头上单独移位的跟颚骨肌腱内颚小腿的。

（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

分析报告经颈椎窦入路交锁髓内头上病人移位的跟颚骨肌腱内颚小腿的。（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，合计归属于64由此可知（男48 女16）74在手。

（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

在所有病由此可知中的，后肌腱面通过颈椎窦入路，有别于1-2枚螺头上单独。在所有肌腱的颚骨块单独后，有别于经皮交锁髓内头上单独，6枚锁定头上。

（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°不对到术后28.6°，肌腱面台阶由术前5.4mm不对到术后0.6mm，术后影像学低分平均2.9。随后皮肤边沿坏死3由此可知（4%），浅表接种1由此可知（1.3%）。经过1年随访，平均AOFAS低分90.2分，平均Maryland后在手低分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 & Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. ）

六、Conclusions

在后肌腱面通过螺头上获得复位后，交锁髓内头上可以作为移位跟颚骨肌腱内颚小腿具有较好的稳定性和更高败血症的一种可选择的新方法。

（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. ）