中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2010年
12期
924-927
,共4页
跟骨%骨折
跟骨%骨摺
근골%골절
Calcaneus%Fractures,bone
目的 比较分析传统跟骨外侧"L"形切口人路和改良经跗骨窦切口入路治疗大龄儿童(8～17岁)跟骨关节内骨折的临床疗效.方法 2000年6月至2008年1月,收治儿童跟骨关节内骨折31例(34足),其中经传统跟骨外侧"L"形切口入路(传统入路)治疗18例(20足),男11例,女7例,年龄(12.5±3.3)岁.改良经跗骨窦有限切口入路(改良入路)治疗13例(14足),男8例,女5例,年龄(13.2±3.5)岁.术前两组患儿一般资料具有可比性.分别对两组患儿术中各项指标,术后并发症、术后疗效进行比较分析.结果 全部病例随访12～45个月,平均24个月.和传统组比较改良经跗骨窦有限切口入路组术中平均失血量少,为(25.42±8.94)ml比(81.53±10.81)ml;切口长度短,为(3.54±0.89)cm比(10.18±1.45)cm;住院时间短,为(5.15±0.58)d比(8.07±2.34)d,相比较差异均有统计学意义(P＜0.01).传统组治疗前后Bo hler角、Gissane角分别为(9.32±12.35)°比(31.1 1±4.62)°和(104.41±6.62)°比(128.72±9.55)°,改良组治疗前后Bohler角、Gissane角分别为(10.28±12.51)°比(34.56±2.74)°和(105.35±7.68)°比(126.71±5.44)°,两组治疗前后Bohler角、Gissane角比较均有统计学意义(P＜0.01).传统入路组发生并发症4例,改良入路组发生并发症2例,两组比较差异无统计学意义(P＞0.05).术后疗效根据美国足踝学会AOFAS踝-后足评分系统评定,传统组:优15足,良3足,可2足,优良率90.00%;改良组:优11足,良2足,可1足,优良率92.86%,两组比较差异无统计学意义(P＞0.05).结论 传统跟骨外侧"L"形切口入路在治疗大龄儿童跟骨关节内骨折总体疗效与改良经跗骨窦有限切口入路相当,都能取得满意疗效,但后者具有创伤小、住院时间短等优点,是一种较有前景的微创入路方式.
目的 比較分析傳統跟骨外側"L"形切口人路和改良經跗骨竇切口入路治療大齡兒童(8～17歲)跟骨關節內骨摺的臨床療效.方法 2000年6月至2008年1月,收治兒童跟骨關節內骨摺31例(34足),其中經傳統跟骨外側"L"形切口入路(傳統入路)治療18例(20足),男11例,女7例,年齡(12.5±3.3)歲.改良經跗骨竇有限切口入路(改良入路)治療13例(14足),男8例,女5例,年齡(13.2±3.5)歲.術前兩組患兒一般資料具有可比性.分彆對兩組患兒術中各項指標,術後併髮癥、術後療效進行比較分析.結果 全部病例隨訪12～45箇月,平均24箇月.和傳統組比較改良經跗骨竇有限切口入路組術中平均失血量少,為(25.42±8.94)ml比(81.53±10.81)ml;切口長度短,為(3.54±0.89)cm比(10.18±1.45)cm;住院時間短,為(5.15±0.58)d比(8.07±2.34)d,相比較差異均有統計學意義(P＜0.01).傳統組治療前後Bo hler角、Gissane角分彆為(9.32±12.35)°比(31.1 1±4.62)°和(104.41±6.62)°比(128.72±9.55)°,改良組治療前後Bohler角、Gissane角分彆為(10.28±12.51)°比(34.56±2.74)°和(105.35±7.68)°比(126.71±5.44)°,兩組治療前後Bohler角、Gissane角比較均有統計學意義(P＜0.01).傳統入路組髮生併髮癥4例,改良入路組髮生併髮癥2例,兩組比較差異無統計學意義(P＞0.05).術後療效根據美國足踝學會AOFAS踝-後足評分繫統評定,傳統組:優15足,良3足,可2足,優良率90.00%;改良組:優11足,良2足,可1足,優良率92.86%,兩組比較差異無統計學意義(P＞0.05).結論 傳統跟骨外側"L"形切口入路在治療大齡兒童跟骨關節內骨摺總體療效與改良經跗骨竇有限切口入路相噹,都能取得滿意療效,但後者具有創傷小、住院時間短等優點,是一種較有前景的微創入路方式.
목적 비교분석전통근골외측"L"형절구인로화개량경부골두절구입로치료대령인동(8～17세)근골관절내골절적림상료효.방법 2000년6월지2008년1월,수치인동근골관절내골절31례(34족),기중경전통근골외측"L"형절구입로(전통입로)치료18례(20족),남11례,녀7례,년령(12.5±3.3)세.개량경부골두유한절구입로(개량입로)치료13례(14족),남8례,녀5례,년령(13.2±3.5)세.술전량조환인일반자료구유가비성.분별대량조환인술중각항지표,술후병발증、술후료효진행비교분석.결과 전부병례수방12～45개월,평균24개월.화전통조비교개량경부골두유한절구입로조술중평균실혈량소,위(25.42±8.94)ml비(81.53±10.81)ml;절구장도단,위(3.54±0.89)cm비(10.18±1.45)cm;주원시간단,위(5.15±0.58)d비(8.07±2.34)d,상비교차이균유통계학의의(P＜0.01).전통조치료전후Bo hler각、Gissane각분별위(9.32±12.35)°비(31.1 1±4.62)°화(104.41±6.62)°비(128.72±9.55)°,개량조치료전후Bohler각、Gissane각분별위(10.28±12.51)°비(34.56±2.74)°화(105.35±7.68)°비(126.71±5.44)°,량조치료전후Bohler각、Gissane각비교균유통계학의의(P＜0.01).전통입로조발생병발증4례,개량입로조발생병발증2례,량조비교차이무통계학의의(P＞0.05).술후료효근거미국족과학회AOFAS과-후족평분계통평정,전통조:우15족,량3족,가2족,우량솔90.00%;개량조:우11족,량2족,가1족,우량솔92.86%,량조비교차이무통계학의의(P＞0.05).결론 전통근골외측"L"형절구입로재치료대령인동근골관절내골절총체료효여개량경부골두유한절구입로상당,도능취득만의료효,단후자구유창상소、주원시간단등우점,시일충교유전경적미창입로방식.
Objective To compare and evaluate the therapeutic effect of traditional L-shaped lateral approach or improved sinus tarsi approach for children from 8 to 17 years with intra-articular fracture of calcaneum. Methods From June 2000 to January 2008, 31 children (34 feet) with intra-articular fracture of calcaneum underwent operation in this institution. Eighteen cases (20 feet) were treated with traditional L-shaped lateral procedure including 11 males and 7 females with the mean age of 12.5 ± 3.3 years. Thirteen cases underwent improved sinus tarsi approach including 8 males and 5 females with the mean age of 13.2 ± 3.5 years. The clinical outcomes and postoperative complications were analyzed. Results All patients were followed up for 12 to 45 months with an average period of 24 months. Significant difference of intraoperative blood loss, length of incision and length of stay was noted between the 2 approaches (all, P＜0.01 ). Bohler angle and Gissane angle were significantly restored after surgery (P＜0.01 ). Four patients treated with the traditional procedure and 2 patients treated improved procedure had complications, however, there was no statistical difference (P＞0.05). There was no statistical difference in the AOFAS scoring between two groups (P＞0.05).Conclusions Both procedures can achieve satisfactory outcomes for older children with intra-articular fracture of calcaneum, while the improved sinus tarsi approach is a minimally invasive technique which can reduce the size of incision and the length of stay.
