CAJ | 학술논문

目的比较腓骨下小切口微创钢板内固定与外侧扩大入路切开复位内固定治疗跟骨关节内骨折的疗效.方法回顾性分析2010年3月至2011年3月采用微创内固定(微创组)与切开复位内固定(外侧扩大入路组)治疗的92例SandersⅢ型跟骨骨折患者资料,根据患者性别、年龄、骨折分型进行配对,共有17对患者纳入.记录两组患者的手术时间、术中及术后出血量、骨折愈合时间及局部并发症的发生情况.应用美国足踝外科协会(AOFAS)踝与后足评分、疼痛视觉模拟(VAS)评分及简明健康状况调查表(SF-36)生活质量评分评价患肢功能恢复情况,并比较两组患者的疗效.结果微创组和外侧扩大入路组患者术后分别获平均14.2、15.3个月随访.微创组与外侧扩大入路组的手术时间平均分别为(84.0±6.1)、(90.8±5.4)min,术中及术后出血量平均分别为(97.4±10.6)、(181.2±10.9) mL,SF-36评分平均分别为(60.2±5.9)、(49.8±5.0)分,两组比较差异均有统计学意义(P＜0.05).微创组与外侧扩大入路组的骨折愈合时间平均分别为(9.5±1.2)、(9.8±1.4)周,AOFAS踝与后足评分平均分别为(91.2±6.6)、(88.7±12.3)分,疼痛VAS评分平均分别为(1.8±0.7)、(1.9±0.7)分,两组比较差异均无统计学意义(P＞0.05).微创组1例患者出现跟腱止点疼痛；外侧扩大入路组1例患者出现伤口感染,1例患者出现术口延迟愈合,两组比较差异无统计学意义(P＞0.05).出现伤口感染,1例患者出现术口延迟愈合,两组患者并发症发生率比较差异无统计学意义(x2=3.000,P=0.223). 结论与切开复位内固定比较,微创内固定在功能评定与并发症发生率方面无明显差异,但更有利于提高患者的生活质量.
목적 비교비골하소절구미창강판내고정여외측확대입로절개복위내고정치료근골관절내골절적료효.방법 회고성분석2010년3월지2011년3월채용미창내고정(미창조)여절개복위내고정(외측확대입로조)치료적92례SandersⅢ형근골골절환자자료,근거환자성별、년령、골절분형진행배대,공유17대환자납입.기록량조환자적수술시간、술중급술후출혈량、골절유합시간급국부병발증적발생정황.응용미국족과외과협회(AOFAS)과여후족평분、동통시각모의(VAS)평분급간명건강상황조사표(SF-36)생활질량평분평개환지공능회복정황,병비교량조환자적료효.결과 미창조화외측확대입로조환자술후분별획평균14.2、15.3개월수방.미창조여외측확대입로조적수술시간평균분별위(84.0±6.1)、(90.8±5.4)min,술중급술후출혈량평균분별위(97.4±10.6)、(181.2±10.9) mL,SF-36평분평균분별위(60.2±5.9)、(49.8±5.0)분,량조비교차이균유통계학의의(P＜0.05).미창조여외측확대입로조적골절유합시간평균분별위(9.5±1.2)、(9.8±1.4)주,AOFAS과여후족평분평균분별위(91.2±6.6)、(88.7±12.3)분,동통VAS평분평균분별위(1.8±0.7)、(1.9±0.7)분,량조비교차이균무통계학의의(P＞0.05).미창조1례환자출현근건지점동통；외측확대입로조1례환자출현상구감염,1례환자출현술구연지유합,량조비교차이무통계학의의(P＞0.05).출현상구감염,1례환자출현술구연지유합,량조환자병발증발생솔비교차이무통계학의의(x2=3.000,P=0.223). 결론 여절개복위내고정비교,미창내고정재공능평정여병발증발생솔방면무명현차이,단경유리우제고환자적생활질량.
Objective To compare minimally invasive plating via a small infero-fibular approach versus open reduction and internal fixation via an extended lateral approach in the treatment of intra-articular fractures of the calcaneus. Methods A retrospective study was conducted to analyze the 92 patients who had been treated in our department for calcaneal fracture of Sanders type Ⅲ form March 2010 to March 2011.They were treated either by minimally invasive plating via a small infero-fibular approach (MI group) or by open reduction and internal fixation via an extended lateral approach (ORIF group).Only 17 pairs of the patients were included in the present study who were matched in sex,age and fracture type.The operation time,intraoperative and postoperative bleeding volume,fracture healing time and local complications for the 2 groups were documented.The therapeutic outcomes were compared between the 2 groups according to the evaluation system of American Orthopaedic Foot and Ankle Society (AOFAS),Visual Analogue Scale (VAS) pain score,and short form 36(SF-36). Results The MI group and the ORIF group obtained a mean follow-up of 14.2 months and of 15.3 months respectively.The MI group and the ORIF group had a mean operation Time of 84.0 ± 6.1 minutes and of 90.8 ± 5.4 minutes, a mean intraoperative and postoperative bleeding volume of 97.4 ± 10.6 mL and of 181.2 ± 10.9 mL,and a mean SF36 score of 60.2 ± 5.9 points and of 49.8 ± 5.0 points,respectively.There were significant differences between the 2 groups regarding the above indexes ( P ＜ 0.05).On average,there were no significant differences between the 2 groups regarding fracture healing time (9.5 ± 1.2 weeks versus 9.8 ± 1.4 weeks),AOFAS score (91.2 ± 6.6 points versus 88.7 ± 12.3 points) and VAS pain score ( 1.8 ± 0.7 points versus 1.9 ± 0.7 points) ( P ＞ 0.05).The MI group had one case of achilles tendon pain and the ORIF group had one case of incision infection and one case of delayed incision healing.There was no significant difference in complications between the 2 groups(x2 =3.000,P =0.223). Conclusion Compared with ORIF in the treatment of intra-articular fractures of the calcaneus,the minimally invasive plating via a small infero-fibular approach can better improve the quality of life of the patient without significant compromises in functional recovery and complications.