跟骨骨折髓内钉内通常

累及后腿部面的跟突突折才可改用疗程化疗已经订下共识，传统外侧“L”型不断扩大入路切口疗程后切口胃癌极少，随着应用的发展，现已发展出经肱突窦入路、腿部镜常规夺权等应用。

权衡跟突内松质突结构，并避免对突膜及骨质血运引致破坏，有学者创新性改用髓内铁钉化疗跟突突折，并做了系列病实有报告，夺得良好的治果。

一、Introduction

由于心绞痛的距下腿部恶性肿瘤和后缘的有机体变化，反向的跟突腿部内突折非疗程化疗通常与妨碍上集特别。因此，有人认为只有对腿部面和跟突的椭圆形展开解剖学重建才能获得更好的长期效果，大多数护士现在都赞成儿科化疗。

在很长一直内，化疗跟突腿部内突折的金国际标准是通过不断扩大外侧入路展开切开夺权内互换。然而，这种方法经常与喉咙软骨胃癌(5.8%-43%)特别，包括血肿、喉咙浅表肿胀、浅表和深部喉咙细菌感染。为了降较差这些风险，在过去几年内，电子式应用得到了很好的发展，包括经皮螺铁钉互换、经肱突窦入路、有限后路和腿部镜常规互换。经肱突窦入路可直接控制腿部夺权，无才可广泛的骨质解剖，并结合经皮内互换，使骨质胃癌发生率较较差。在这项研究中，我们旨在评核经肱突窦入路经皮螺铁钉互换反向的跟突腿部内突折的。

（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

评核经肱突窦入路交锁髓内铁钉化疗反向的跟突腿部内突折的。（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，共纳入64实有（男48 女16）74缘。

（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

在所有病实有中，后腿部面通过肱突窦入路，改用1-2枚螺铁钉互换。在所有腿部的突块互换后，改用经皮交锁髓内铁钉互换，6枚意味著铁钉。

（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°缺失到术后28.6°，腿部面台阶由术前5.4mm缺失到术后0.6mm，术后检查和总分少于2.9。随后皮肤边缘肿胀3实有（4%），浅表细菌感染1实有（1.3%）。经过1年随访，少于AOFAS总分90.2分，少于Maryland后缘总分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

在后腿部面通过螺铁钉获得夺权后，交锁髓内铁钉可以作为反向跟突腿部内突折具有较好的稳定性和较差胃癌的一种须要的方法。

（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. ）