【摘要】 目的 探讨四区置钉技术在闭合复位微创空心钉固定治疗跟骨骨折的手术技巧及临床疗效。方法 回顾性分析了自2023年12月至2024年6月于上海市第六人民医院应用四区置钉技术进行闭合复位、微创空心钉固定治疗的跟骨骨折患者89例。记录患者的术前等待时间、手术时间、住院时间、骨折愈合时间及术后并发症情况，比较患者术前术后跟骨长度、高度、宽度，以及跟骨B?hler角和Gissane角的恢复情况，采用AOFAS踝-后足评分对足部功能进行评定。结果 89例纳入患者中男70例，女19例，年龄22～68岁，平均年龄（44.1±9.7）岁，术前等待时间2～10 d，平均（2.7±1.1）d。手术时间为45～170 min，平均为（99.8±34）min；住院时间为3～6 d，平均为（4.0±0.7）d。62例患者获得随访，术后随访时间6～13个月，平均（9.7±2.1）个月，62例患者骨折均获得一期骨性愈合，愈合时间2～6个月，平均（3.5±0.9）个月；无切口感染、皮肤坏死等并发症发生。末次随访时跟骨的长度、高度、宽度，以及B?hler角、Gissane角和AOFAS评分均较术前明显改善，差异有统计学意义（P<0.05）。结论 应用四区置钉技术闭合复位、微创空心钉固定治疗跟骨骨折，具有操作微创、固定效果良好、术后恢复快等优点，手术操作技术易于推广，为临床微创治疗跟骨骨折提供了一种选择。更多还原

【Abstract】 Objective To explore the surgical technique and clinical efficacy of the four-zones-screws technique for the treatment of calcaneal fractures with closed reduction and minimally invasive screw fixation(CRMIF). Methods A retrospective analysis was conducted on 89 patients with calcaneal fractures who received treatment with the four-zonesscrews technique for closed reduction and minimally invasive screw fixation from December 2023 to June 2024 at Shanghai Sixth People’s Hospital. The preoperative waiting time, operative time, hospital stay, fracture healing time, and postoperative complications were recorded. The calcaneal length, height, width, and the recovery of B?hler angle and Gissane angle were compared before and after surgery. The American Orthopaedic Foot & Ankle Society(AOFAS) anklehindfoot score was used to evaluate foot function. Results Among the 89 patients, there were 70 males and 19 females, with an age range of 22 to 68 years [(44.1±9.7) years]. Operative time ranged from 45-170 min, with an average of(99.8±34) min. Hospital stays ranged from 3-6 d, with an average of(4.0±0.7) d. Sixty-two patients were followed up for 6-13 months, with an average of(9.7±2.1) months. All 62 patients achieved primary bony healing postoperatively, with a healing time of 2-6 months and an average of(3.5±0.9) months; no incision infections, skin necrosis, or other complications occurred. The preoperative waiting time was 2-10 d, with an average of(2.7±1.1) d. At the last follow-up, the calcaneal length, height, width, B?hler angle, Gissane angle, and AOFAS score were significantly improved compared to preoperatively, and the difference was statistically significant(P<0.05). Conclusion The application of the four-zonesscrews technique in the treatment of calcaneal fractures has the advantages of minimal invasiveness, a reduced hospital stay, a decreased incidence of related surgical complications, good fixation and a rapid postoperative recovery. The surgical technique provides an option for the clinical minimally invasive treatment of calcaneal fractures.更多还原