CAJ | 학술논문

目的根据骨折的不同类型,分别采用保守治疗、撬拨复位和切开复位等方法治疗大龄儿童跟骨关节内骨折,并分析其疗效,总结适宜的治疗策略.方法回顾分析2001年5月至2009年2月收治的39例42足儿童跟骨关节内骨折的临床资料,其中保守治疗9足(均为Sanders Ⅰ型);撬拨复位治疗14足(SandersⅡ型10足,SandersⅢ型4足);切开复位治疗19足(SandersⅡ型8足,SandersⅢ型7足,SandersⅣ型4足).结果随访15～73个月,平均36.2个月,随访时骨折均获愈合.手术组的B(o)hler角和Gissane角治疗前后比较分别是(17.6±6.3)°比(32.4±2.3)°和(137.9±11.6)°比(124.8±4.7)°,差异有统计学意义(P＜0.01).按Maryland评分,保守治疗优良率为100%,撬拨复位优良率为85.7%,切开复位优良率为84.2%,总体优良率为88.1%.结论儿童跟骨关节内骨折治疗方式的选择应根据患儿的个体状况、骨折类型等综合考虑.Sanders Ⅰ型骨折可采取保守治疗;外侧壁膨出不明显的SandersⅡ型骨折及软组织条件较差者,可选用撬拨复位;外侧壁膨出明显的SandersⅡ型骨折和复杂的Sanders Ⅲ、Ⅳ型骨折,无手术禁忌者,宜选择切开复位.
목적 근거골절적불동류형,분별채용보수치료、효발복위화절개복위등방법치료대령인동근골관절내골절,병분석기료효,총결괄의적치료책략.방법 회고분석2001년5월지2009년2월수치적39례42족인동근골관절내골절적림상자료,기중보수치료9족(균위Sanders Ⅰ형);효발복위치료14족(SandersⅡ형10족,SandersⅢ형4족);절개복위치료19족(SandersⅡ형8족,SandersⅢ형7족,SandersⅣ형4족).결과 수방15～73개월,평균36.2개월,수방시골절균획유합.수술조적B(o)hler각화Gissane각치료전후비교분별시(17.6±6.3)°비(32.4±2.3)°화(137.9±11.6)°비(124.8±4.7)°,차이유통계학의의(P＜0.01).안Maryland평분,보수치료우량솔위100%,효발복위우량솔위85.7%,절개복위우량솔위84.2%,총체우량솔위88.1%.결론 인동근골관절내골절치료방식적선택응근거환인적개체상황、골절류형등종합고필.Sanders Ⅰ형골절가채취보수치료;외측벽팽출불명현적SandersⅡ형골절급연조직조건교차자,가선용효발복위;외측벽팽출명현적SandersⅡ형골절화복잡적Sanders Ⅲ、Ⅳ형골절,무수술금기자,의선택절개복위.
Objective To review our experience of managing treat intraarticular calcaneal fractures in older children with non-operative approach, closed reduction and open reduction depending on fracture type. Methods A retrospective study was done on 42 intraarticular calcaneal fractures in 39 children treated in our department from May 2001 to February 2009. Among them, 9 patients were treated conservatively (all type Sanders Ⅰ fractures), 14 treated with closed reduction (10 patients with type Sanders Ⅱ fractures and 4 with type Sanders Ⅲ),and 19 treated with open reduction(8 patients with type Sanders Ⅱ fractures, 7 with type Sanders Ⅲ and 4 with type Sanders Ⅳ). Results The average follow-up was 36. 2 months(range, 15-73 months). All patients had a complete healing of their fractures. There was a significant difference in the operative group as to the restoration of B(o)hler angle and Gissane angle before and after operation(P ＜ 0. 01). According to Maryland Foot Score, the excellent or good rate was 100% in conservative treatment, 85. 7% inn closed reduction and 84. 2% in open reduction respectively. The overall excellent or good rate was 88. 1 %. Conclusions Therapeutic plan should be developed on patients' clinical conditions and fracture type. Conservative treatment can be used for type Sanders Ⅰ fractures. Closed reduction is alternative for part of type Sanders Ⅱ fractures without the widen posterior facet, and the patients whose soft tissues condition are poor. Open reduction is recommended for type Sanders Ⅱ with the widen posterior facet, type Sanders Ⅲ and type Sanders Ⅳ fractures.