CAJ | 학술논문

目的评价植骨在跟骨关节内骨折切开复位钢板内固定手术治疗中的价值.方法 2005年1月至2011年8月,接受切开复位钢板内固定手术治疗的跟骨关节内骨折182例.男159例,女23例；平均41.2岁.单纯左侧跟骨骨折68例,单纯右侧跟骨骨折86例,双侧跟骨骨折28例,均为闭合骨折.骨折根据Sander分型:Ⅱ型27例,Ⅲ型109例,Ⅳ型46例.182例患者分为植骨组(94例)、未植骨组(88例),分型比较差异有统计学意义(P＜0.05).手术均应用跟骨外侧切口,切开复位异型钢板内固定术.采用美国足踝外科学会(AOFAS)评分行足踝功能评分.结果 10例患者3个月后失随访,172例获得随访,随访时间平均14.2个月.骨折愈合时间8～15周,平均12周,骨折均愈合,无神经损伤,骨髓炎.未植骨组29例负重后关节面出现塌陷,21例合并距下关节创伤性关节炎.植骨组未出现关节面塌陷,1例合并距下关节创伤性关节炎.植骨组优68例,良20例,可5例,差1例；未植骨组优44例,良26例,可7例,差9例,优良率为87.9％.两组术后的AOFAS评分比较差异有统计学意义(P＜0.05).结论植骨对提高跟骨关节内骨折手术疗效有重要意义.
목적 평개식골재근골관절내골절절개복위강판내고정수술치료중적개치.방법 2005년1월지2011년8월,접수절개복위강판내고정수술치료적근골관절내골절182례.남159례,녀23례；평균41.2세.단순좌측근골골절68례,단순우측근골골절86례,쌍측근골골절28례,균위폐합골절.골절근거Sander분형:Ⅱ형27례,Ⅲ형109례,Ⅳ형46례.182례환자분위식골조(94례)、미식골조(88례),분형비교차이유통계학의의(P＜0.05).수술균응용근골외측절구,절개복위이형강판내고정술.채용미국족과외과학회(AOFAS)평분행족과공능평분.결과 10례환자3개월후실수방,172례획득수방,수방시간평균14.2개월.골절유합시간8～15주,평균12주,골절균유합,무신경손상,골수염.미식골조29례부중후관절면출현탑함,21례합병거하관절창상성관절염.식골조미출현관절면탑함,1례합병거하관절창상성관절염.식골조우68례,량20례,가5례,차1례；미식골조우44례,량26례,가7례,차9례,우량솔위87.9％.량조술후적AOFAS평분비교차이유통계학의의(P＜0.05).결론 식골대제고근골관절내골절수술료효유중요의의.
Objective To evaluate the efficacies of treating intra-calcaneal fractures with bone grafting.Methods From January 2005 to October 2011,a total of 182 calcaneal patients underwent operations for closed fractures.There were 159 males and 23 females with an average age of 41.2 years old.The fractures were of the following types: left calcaneal ( n =68 ),right calcaneal ( n =86) and bilateral (n =28).According to the Sander's classification,there were type Ⅱ ( n =27),type Ⅲ ( n =109 ) and type Ⅳ ( n =46).And they were divided into bone graft ( n =94) and non-bone graft ( n =88 ) groups.All of them underwent a profiled plate fixation via a lateral approach.No external fixation was necessary and early ankle functional exercises started postoperatively.They handled partial weight-bearing at Week 6 and full weight-bearing at Week 12.Their outcomes were assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) while classification comparison affected the prognosis (P ＜0.05).Results The follow-ups of 10 patients were lost at Month 3.And 172 cases were followed up for an average period of 14.2 months (range:9 -16).The average healing duration was 12 weeks (range:6- 15 ).None of follow-up cases had any complication,such as vascular and nerve injury and osteomyelitis.Twentynine cases in the non-bone graft group had articular cave-in after weight bearing.And 21 cases were associated with subtalus arthritis.And in the bone graft group,there was no articular cave-in and only 1 case was associated with subtalus arthritis.The outcomes of bone graft and non-graft groups were as follows:excellent (n =68),good (n=20),fair (n=5) and poor (n=1) vs.excellent (n =44),good (n=26),fair (n =7) and poor (n =9).The rate of excellent and good was 87.9％.And the post-operative AOFAS scores had statistical differences between 2 groups (P ＜ 0.05 ).Conclusion Bone grafting is important for improving the therapeutic efficacies for intra-calcaneal fractures.