中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
8期
751-755
,共5页
跟骨%骨折%骨折固定术,内
跟骨%骨摺%骨摺固定術,內
근골%골절%골절고정술,내
Calcaneus%Fractures,bone%Fracture fixation,internal
目的 探讨改良外侧“L”形切口治疗跟骨关节内移位骨折的临床疗效.方法 自2005年1月至2011年10月收治跟骨关节内移位骨折患者133例143足,男125例,女8例;年龄19～65岁,平均43.2岁.左侧56例,右侧67例,双侧10例,均为闭合骨折.其中3例合并脊柱损伤.根据Sanders分型:Ⅱ型15足、Ⅲ型107足、Ⅳ型21足.均采用外侧改良“L”型切口,切开复位异型钢板内固定.术后均未给予石膏外固定,早期行踝关节功能练习,术后6周部分负重,12周完全负重.采用美国足与踝关节外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统评价术后足踝功能.结果 125例135足获得随访(8例8足术后12周后失访),随访时间12～28个月,平均18.5个月.骨折均愈合,愈合时间8～16周,平均13周.无神经损伤,骨髓炎.4足切口裂开,骨折愈合内固定钢板取出后皮肤愈合.17足发生距下关节创伤性关节炎,行走时疼痛.5足负重后关节面出现塌陷.根据AOFAS踝与后足功能评分系统,优94例、良29例、可14例、差6例,优良率为92.9％.结论 应用改良外侧切口切开复位异型钢板内固定治疗跟骨关节内移位骨折可以获得满意疗效,但在临床应用中需要掌握熟练手术技术.
目的 探討改良外側“L”形切口治療跟骨關節內移位骨摺的臨床療效.方法 自2005年1月至2011年10月收治跟骨關節內移位骨摺患者133例143足,男125例,女8例;年齡19～65歲,平均43.2歲.左側56例,右側67例,雙側10例,均為閉閤骨摺.其中3例閤併脊柱損傷.根據Sanders分型:Ⅱ型15足、Ⅲ型107足、Ⅳ型21足.均採用外側改良“L”型切口,切開複位異型鋼闆內固定.術後均未給予石膏外固定,早期行踝關節功能練習,術後6週部分負重,12週完全負重.採用美國足與踝關節外科協會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與後足功能評分繫統評價術後足踝功能.結果 125例135足穫得隨訪(8例8足術後12週後失訪),隨訪時間12～28箇月,平均18.5箇月.骨摺均愈閤,愈閤時間8～16週,平均13週.無神經損傷,骨髓炎.4足切口裂開,骨摺愈閤內固定鋼闆取齣後皮膚愈閤.17足髮生距下關節創傷性關節炎,行走時疼痛.5足負重後關節麵齣現塌陷.根據AOFAS踝與後足功能評分繫統,優94例、良29例、可14例、差6例,優良率為92.9％.結論 應用改良外側切口切開複位異型鋼闆內固定治療跟骨關節內移位骨摺可以穫得滿意療效,但在臨床應用中需要掌握熟練手術技術.
목적 탐토개량외측“L”형절구치료근골관절내이위골절적림상료효.방법 자2005년1월지2011년10월수치근골관절내이위골절환자133례143족,남125례,녀8례;년령19～65세,평균43.2세.좌측56례,우측67례,쌍측10례,균위폐합골절.기중3례합병척주손상.근거Sanders분형:Ⅱ형15족、Ⅲ형107족、Ⅳ형21족.균채용외측개량“L”형절구,절개복위이형강판내고정.술후균미급여석고외고정,조기행과관절공능연습,술후6주부분부중,12주완전부중.채용미국족여과관절외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)과여후족공능평분계통평개술후족과공능.결과 125례135족획득수방(8례8족술후12주후실방),수방시간12～28개월,평균18.5개월.골절균유합,유합시간8～16주,평균13주.무신경손상,골수염.4족절구렬개,골절유합내고정강판취출후피부유합.17족발생거하관절창상성관절염,행주시동통.5족부중후관절면출현탑함.근거AOFAS과여후족공능평분계통,우94례、량29례、가14례、차6례,우량솔위92.9％.결론 응용개량외측절구절개복위이형강판내고정치료근골관절내이위골절가이획득만의료효,단재림상응용중수요장악숙련수술기술.
Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type Ⅲ,and 21 type Ⅳ.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were used to access outcomes.Results One hundred and twenty five patients (135 feet) were followed up for 12 to 28 months (average,18.5months).All fractures healed after an average of 13 weeks (range,8-16 weeks).There were on nerve injury or osteomyelitis.Incision dehiscence occurred in 4 feet,which healed after removing the plate.Subtalar joint traumatic arthritis occurred in 17 feet,with walking pain.Collapse of articular surface occurred in 5 feet after weight-bearing.According to AOFAS ankle-hindfoot scale,excellent result was got in 94 cases,good in 29 cases,fair in 14 cases,poor in 6 cases; and the excellent and good rate was 92.9％.Conclusion Open reduction and internal fixation via modified lateral L-shaped incision for treating displaced intra-articular calcaneal fractures can obtain satisfactory results,but the skilled surgical techniques are needed.
