CAJ | 학술논문

目的探讨跟骨移位关节内骨折切开复位异型钢板手术治疗的临床疗效.方法自2005年1月至2010年12月天津医院创伤骨科收治并获得随访的跟骨移位关节内骨折患者103例,男92例,女11例,年龄23 ～65岁,平均45.8岁.左跟骨51例,右跟骨40例,双跟骨骨折12例,均为闭合骨折,2例并发脊柱损伤.骨折根据Sander分型,SanderⅡ型15例,SanderⅢ型75例,SanderⅣ型13例.所有患者均应用改良跟骨外侧切口,切开复位异型钢板内固定术,术后6周部分负重,12周完全负重.采用美国足踝外科学会(AOFAS)评分行足踝功能评分.结果 95例获得随访,随访时间6 ～30个月,平均18个月.骨折愈合时间8～15周,平均12周.2例切口裂开,骨折愈合钢板取出后皮肤切口愈合.8例合并距下关节创伤性关节炎,行走时疼痛.3例负重后关节面出现塌陷.根据美国足踝外科学会(AOFAS)足部评分标准,其中优83例,良13例,可5例,差2例,优良率为93.2％.结论改良外侧切口治疗跟骨移位关节内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.
목적 탐토근골이위관절내골절절개복위이형강판수술치료적림상료효.방법 자2005년1월지2010년12월천진의원창상골과수치병획득수방적근골이위관절내골절환자103례,남92례,녀11례,년령23 ～65세,평균45.8세.좌근골51례,우근골40례,쌍근골골절12례,균위폐합골절,2례병발척주손상.골절근거Sander분형,SanderⅡ형15례,SanderⅢ형75례,SanderⅣ형13례.소유환자균응용개량근골외측절구,절개복위이형강판내고정술,술후6주부분부중,12주완전부중.채용미국족과외과학회(AOFAS)평분행족과공능평분.결과 95례획득수방,수방시간6 ～30개월,평균18개월.골절유합시간8～15주,평균12주.2례절구렬개,골절유합강판취출후피부절구유합.8례합병거하관절창상성관절염,행주시동통.3례부중후관절면출현탑함.근거미국족과외과학회(AOFAS)족부평분표준,기중우83례,량13례,가5례,차2례,우량솔위93.2％.결론 개량외측절구치료근골이위관절내골절가이획득만의료효,단재림상응용중수요장악숙련수술기술.
Objective To explore the clinical efficacies of displaced intra-calcaneal fractures with operative treatment.Methods From January 2005 to December 2010,103 calcaneal patients (92 males,11 females) were recruited.The mean age was 45.8 years old ( range:23 - 65 ).All received operative treatment.They included left calcaneal fractures (n =51 ),right calcaneal fractures (n =40) and bilateral calcaneal fractures (n =12 ).All patients were of closed fractures.According to the Sanders classification,there were type Ⅱ ( n =15 ),type Ⅲ ( n =75 ) and type Ⅳ ( n =13 ).A modified lateral approach with profiled plate fixation was adopted for all.Partial weight-bearing occurred at 6 weeks and full weight-bearing at 12 weeks.Function assessment was made with the American Orthopedic Foot and Ankle Society anklehindfoot scale (AOFAS).Results The mean follow-up period was 18 months ( range:6 -30) and the mean healing duration 12 weeks (range:8 - 15 ).Two cases had incision dehiscence.After the removal of plate,the skin healed.Eight cases were associated with subtalus arthritis and painful walking.Three cases of caved calcaneal surface appeared after weight-bearing.According to the AOFAS foot score,the outcomes were excellent ( n =83 ),good ( n =13 ),fair ( n =5 ) and poor ( n =2 ).And the excellent and good rate was 93.2％.Conclusion With a modified lateral approach,displaced intra-calcaneal fracture may be treated with a satisfactory clinical efficacy.But an orthopedic surgeon should master skillful surgical techniques.