目的：讨论经跗骨窦入路有限切开联合微型锁定钢板内固定，结合“排钉技术”固定距下关节面治疗跟骨关节内骨折的临床效果。方法：回顾安徽医科大学第三附属医院2013年10月至2015年12月收治的60例(63足)跟骨关节内骨折的患者(Sanders分型：Ⅱ型35足，Ⅲ型28足)，经跗骨窦切口置入微型锁定钢板以及螺钉的内固定方法，距下关节面采用“排钉技术”固定来治疗跟骨关节内的骨折，通过对比手术前后跟骨的高度、宽度以及Böhler角的变化和术后并发症的发生率，采用Maryland足部评分标准来确定手术效果。结果：所有患者获得10~24个月随访，平均随访18.7个月，末次随访时骨折均达到临床愈合标准。末次随访时跟骨的宽度由术前(39.75±5.58) mm恢复至(37.04±5.83) mm，跟骨高度由术前(38.75±5.38) mm恢复至(41.46±5.68) mm，跟骨Böhler角由术前平均11.07°±13.39°，恢复至末次随访时30.6°±4.64°，差异有统计学意义(P<0.05)；使用Maryland足部评分系统评价术后功能恢复情况：优23足，良32足，可8足，优良率为87.3%；手术并发症的发生概率9.5%。结论：经跗骨窦切口联合微型钢板，结合“排钉技术”固定距下关节面用以治疗跟骨关节内的骨折复位效果较满意，可以有效维持骨折复位，并且能够最大程度地减少软组织的损伤。
Fixation with a mini-locking plate via mini-open sinus tarsi approach for closed displaced intra-articular calcaneal fractures
Objective: To evaluate the fixation with a mini-locking plate via the mini-open sinus tarsi approach for intra-articular calcaneal fractures. Methods: Sixty-three patients with closed calcaneal fracture were treated with mini-locking plate via the mini-open sinus tarsi approach from October 2013 to December 2015. Patients were underwent a careful clinical and radiographic examination and evaluated with the Böhler angle, height and width of calcaneus before operation and at the last follow-up. The final curative effect was assessed according to the Maryland foot score. Results: All the patients were followed up for 10 to 24 months (mean, 18.7 months). The width of the calcaneus has restored to (37.04±5.83) mm at the last follow-up, while the width was (39.75±5.58) mm before the surgery. The heel bone height of the calcaneus has restored to (41.46±5.68) mm at the last follow-up, while the height is (38.75±5.38) mm before the surgery. The Böhler angle of the calcaneus has restored to 30.6°±4.64° at the last follow-up, while the height is 11.07°±13.39° before the surgery. There was significant difference of Böhler angle, height and width of calcaneus (P<0.05). According to Maryland foot score system, an excellent and good outcome of 87.3% was achieved, which the excellent, good and pass number of feet are 23, 32, 8. The complication formation rate is 9.5%. Conclusion: Sinus tarsi approach with a mini-locking plate technique is an effective method for the treatment of calcaneal fractures. It has the advantages of limit soft tissue complications, stable fixation, and early ambulation.