CAJ | 학술논문

目的观察用跟骨钢板治疗跟骨关节内骨折的疗效,并探讨手术前后Bohler角(B角)、Gissane角(G角)与疗效的关系.方法收集2001年1月至2007年8月在本院接受跟骨钢板切开复位内固定治疗跟骨关节内骨折并获得随访的患者55例65足,其中Sanders Ⅱ型16足、Ⅲ型22足、Ⅳ型27足.随访时间15～68个月,平均(33.9±13.9)个月.对患者疗效进行Kerr评分,分析术前、术后跟骨的B角、G角及其术前后的差值与术后功能评分的关系.结果术后Kerr功能评分平均得分(83.5±12.4)分,优良率86.2%;其中Sanders Ⅱ型平均得分(91.5±9.5)分,优良率100%;Ⅲ型(82.5±14.4)分,优良率81.8%;Ⅳ型(79.5±10.1)分,优良率81.5%.多元线性回归分析结果显示,患者术前、术后B角及B角手术前后的差值均是术后功能评分的正性决定因素(P均<0.05),术前、术后G角及G角手术前后的差值不是术后功能评分的决定因素(P均>0.05).结论用跟骨钢板治疗跟骨关节内骨折是一种可早期恢复功能的良好方法.B角可以作为判断治疗跟骨骨折临床疗效的指标,G角对临床疗效没有影响.
목적관찰용근골강판치료근골관절내골절적료효,병탐토수술전후Bohler각(B각)、Gissane각(G각)여료효적관계.방법수집2001년1월지2007년8월재본원접수근골강판절개복위내고정치료근골관절내골절병획득수방적환자55례65족,기중Sanders Ⅱ형16족、Ⅲ형22족、Ⅳ형27족.수방시간15～68개월,평균(33.9±13.9)개월.대환자료효진행Kerr평분,분석술전、술후근골적B각、G각급기술전후적차치여술후공능평분적관계.결과술후Kerr공능평분평균득분(83.5±12.4)분,우량솔86.2%;기중Sanders Ⅱ형평균득분(91.5±9.5)분,우량솔100%;Ⅲ형(82.5±14.4)분,우량솔81.8%;Ⅳ형(79.5±10.1)분,우량솔81.5%.다원선성회귀분석결과현시,환자술전、술후B각급B각수술전후적차치균시술후공능평분적정성결정인소(P균<0.05),술전、술후G각급G각수술전후적차치불시술후공능평분적결정인소(P균>0.05).결론용근골강판치료근골관절내골절시일충가조기회복공능적량호방법.B각가이작위판단치료근골골절림상료효적지표,G각대림상료효몰유영향.
Objective To observe the efficacy of using plate for intra-articular calcaneal fractures, and to explore the relationship of the efficacy with Bohler's angle and Gissane's angle before and after operation. Methods From January 2001 to August 2007, 55 cases 65 feet with calcaneal fractures,including Sanders type Ⅱ 16 feet, type Ⅲ 22 feet and type Ⅳ 27 feet, which received open reduction and internal fixation with calcaneal plates were followed-up for(33.9±13.9) months ( range 15 to 68 months ). The efficacy was validated according to the score criterion designed by Kerr. At the same time, the Bohler's angle and Gissane's angle were measured before and after operations. Then, multivariate regression analysis was applied to evaluate the relationship between recovery scores and angles degrees. Results The overall average recovery score was 83.5±12.4 after operation, and the excellent and good rate was 86.2%. In addition, the average recovery scores of Sanders type Ⅱ, type Ⅲ and type Ⅳ were 91.5±9.5,82.5±14.4 and 79.5± 10.1 respectively,and the excellent and good rates were 100% ,81.8% and 81.5% respectively. Multiple linear regression analysis showed that the Bohler's angle before operation, Bohler's angle after operation and the difference of postoperative and preoperative Bohler's angle were positive determinants of the postoperative recovery score( all P<0.05 ); the Gissane's angle before operation, Gissane's angle after operation and the difference of postoperative and preoperative Gissane's angle were not the determinants of the postoperative recovery score( all P>0.05 ). Conclusions Internal fixation with calcaneal plate for intra-articular calcaneal fracture is a good method for restoration of function early after operation. Bohler's angle can be used as an indicator of clinical efficacy. Gissane's angle is not an effective clinical indicator.