CAJ | 학술논문

目的介绍撬拨复位结合Ilizarov技术治疗足跟皮肤软组织条件不良的跟骨关节内骨折的方法.方法自2007年9月至2009年9月,应用该方法治疗足跟皮肤软组织条件不良的跟骨关节内骨折11例,男10例,女1例;年龄21～50岁,平均33.6岁.左4例,右7例.骨折采用Sanders分型:Ⅱ型7例,Ⅲ型3例,Ⅳ型1例.软组织损伤采用AO闭合软组织损伤分型:IC2型3例,IC3型6例,IC5型1例及皮肤开放撕脱伤1例.术前B(o)hler角0°～12°,平均8°;Gissane角70°～95°,平均80°.手术方法:跟骨结节外侧插入骨圆针撬拨复位后关节面骨块,再利用打入的橄榄针的拉张纠正跟骨内、外侧骨块的移位,并用llizarov环形支架同定.结果 11例患者全部获得随访,时间6～20个月,平均13.3个月.骨折全部愈合,愈合时问7～10周,平均8.1周.术后B(o)hler角20°～45°,平均33°;Gissane角100°～118°,平均107°.对按Maryland足部评分系统评价术后功能,优7例,良3例,可1例,优良率为91%.结论撬拨复位结合Ilizarov技术可以恢复并维持跟骨正常的解剖形态,减少伤口感染等术后并发症的发生;尤其适用于Sanders II、III型伴软组织损伤严重的闭合骨折或开放骨折;掌握好手术适应证及操作要点可以取得满意的临床疗效.
목적 개소효발복위결합Ilizarov기술치료족근피부연조직조건불량적근골관절내골절적방법.방법 자2007년9월지2009년9월,응용해방법치료족근피부연조직조건불량적근골관절내골절11례,남10례,녀1례;년령21～50세,평균33.6세.좌4례,우7례.골절채용Sanders분형:Ⅱ형7례,Ⅲ형3례,Ⅳ형1례.연조직손상채용AO폐합연조직손상분형:IC2형3례,IC3형6례,IC5형1례급피부개방시탈상1례.술전B(o)hler각0°～12°,평균8°;Gissane각70°～95°,평균80°.수술방법:근골결절외측삽입골원침효발복위후관절면골괴,재이용타입적감람침적랍장규정근골내、외측골괴적이위,병용llizarov배형지가동정.결과 11례환자전부획득수방,시간6～20개월,평균13.3개월.골절전부유합,유합시문7～10주,평균8.1주.술후B(o)hler각20°～45°,평균33°;Gissane각100°～118°,평균107°.대안Maryland족부평분계통평개술후공능,우7례,량3례,가1례,우량솔위91%.결론 효발복위결합Ilizarov기술가이회복병유지근골정상적해부형태,감소상구감염등술후병발증적발생;우기괄용우Sanders II、III형반연조직손상엄중적폐합골절혹개방골절;장악호수술괄응증급조작요점가이취득만의적림상료효.
Objective To introduce the treatment of intraarticular calcaneal fractures with poor soft tissue using poking reduction combined with Ilizarov methods. Methods From September 2007 to September 2009,11 patients with the intraarticular calcaneal fractures were treated with poking reduction combined with Ilizarov methods,including 10 males and 1 female at average age of 33.6 years(range,21-50 years).Four patients had the left calcaneal fractures and seven with the right ones.According to Sander classification,there were seven patients with type II fractures,three with type III fractures and one with type IV fracture.The various extents of heel soft tissue injury were emerged in all the patients.Before operation,B(o)hler angle was 0°-12°(average 8°)and Gissane angle 70°-95°(average 80°).According to AO classification of close soft tissue injury,there were three patients with type IC2,six with type IC3,one with type IC5 and one with open soft tissue injury.The collapse of the articular surface was recovered by Steinmann pin which passed through the lateral calcaneal tubercle.The medial and lateral fracture fragments were corrected by using the tensed olive wires.The heighat and width were maintained by using the Ilizarov external fixation. Results The mean duration of follow-up was 13.3 months (range,6-20 months).All fractures were healed after mean duration for 8.1 weeks(range,7-10weeks).The postoperative B(o)hler angle was 20°-45°(average 33°)and Gissane angle 100°-118°(average 107°).According to Maryland Foot Score system,the result of postoperative function was excellent in seven patients,good in three and fair in one,with excellence rate of 91%. Conclusions For the intraarticular calcaneal fractures,the poking reduction combined with Ilizarov method is able to recover and maintain the normal calcaneal height and width and reduce postoperative wound infections and many other complications.specially for Sanders II or III with severe soft tissue injury in the open or closed calcaneal fractures.Master of surgical indications and operating poims can attain satisfactory clinical efficacy.