CAJ | 학술논문

目的探讨Rtedi-Allg(o)werⅢ型pilon骨折术后踝穴形态改变与术后踝关节功能的相关性.方法回顾性分析2006年1月至2010年1月手术治疗并获得随访的47例Rüedi-Allg(o)werⅢ型pilon骨折患者,男20例,女27例；年龄21～65岁,平均43岁；随访时间18～24个月,平均21个月.在末次随访时所摄X线片上测量如下指标:(1)踝穴高度,(2)踝穴宽度,(3)踝穴深度,(4)踝穴冠状位角度,(5)踝穴矢状位角度.根据Mazur等评分方法,对末次随访时患侧踝关节功能进行评分并分组,其中优组28例,良组11例,可+差组8例.通过对47例患者患侧与健侧踝穴五项指标的比较及对三组间各项指标患侧与健侧差值比较,分析踝穴形态改变与功能的相关性.结果研究显示47例患者患侧与健侧踝关节各项指标比较,除踝穴高度无统计学差异外,踝穴宽度、深度、冠状位和矢状位角度比较,差异均有统计学意义.优、良、可+差三组踝穴各项指标患侧与健侧差值比较,除高度差值与评分无相关外,余四项差值均与评分呈负相关,随评分等级降低差值变大,说明术中踝穴宽度、深度、冠状位及矢状位角度的处理与术后踝关节功能显著相关.结论 Rüedi-Allg(o)werⅢ型pilon骨折患者术中踝穴宽度、深度、冠状位及矢状位角度的解剖复位对术后踝关节功能有显著影响,故术中应尽可能恢复踝穴的解剖形态.
목적 탐토Rtedi-Allg(o)werⅢ형pilon골절술후과혈형태개변여술후과관절공능적상관성.방법 회고성분석2006년1월지2010년1월수술치료병획득수방적47례Rüedi-Allg(o)werⅢ형pilon골절환자,남20례,녀27례；년령21～65세,평균43세；수방시간18～24개월,평균21개월.재말차수방시소섭X선편상측량여하지표:(1)과혈고도,(2)과혈관도,(3)과혈심도,(4)과혈관상위각도,(5)과혈시상위각도.근거Mazur등평분방법,대말차수방시환측과관절공능진행평분병분조,기중우조28례,량조11례,가+차조8례.통과대47례환자환측여건측과혈오항지표적비교급대삼조간각항지표환측여건측차치비교,분석과혈형태개변여공능적상관성.결과 연구현시47례환자환측여건측과관절각항지표비교,제과혈고도무통계학차이외,과혈관도、심도、관상위화시상위각도비교,차이균유통계학의의.우、량、가+차삼조과혈각항지표환측여건측차치비교,제고도차치여평분무상관외,여사항차치균여평분정부상관,수평분등급강저차치변대,설명술중과혈관도、심도、관상위급시상위각도적처리여술후과관절공능현저상관.결론 Rüedi-Allg(o)werⅢ형pilon골절환자술중과혈관도、심도、관상위급시상위각도적해부복위대술후과관절공능유현저영향,고술중응진가능회복과혈적해부형태.
Objective To investigate the relationship between the imaging manifestations and postoperative efficacy scores through measuring postoperative ankle mortise morphometry of Rüedi-Allg(o)wer Ⅲ pilon fracture.Methods Forty-seven cases of Rüedi-Allg(o)wer Ⅲ pilon fracture patients,including 20 males and 27 females with a mean of 43 years (range,21-65 years) were treated and followed up.Indexes including the width,height,depth,coronal angle and sagittal angle of ankle mortise were measured at the last follow-up.According to the Mazur score at the last follow-up,operated ankle functions were evaluated and divide into three groups (excellent group,good group and poor group.By comparing the five indexes of 47 cases and 3 groups between injury ankle and healthy ankle,we analyzed the correlation of the ankle mortise change and the ankle function.Results All patients were followed up 18-24 months (mean,21 months).The results showed there were significant differences about all the measuring indexes except the height of ankle mortise between the injury ankle and healthy ankle of 47 follow-up cases.About the difference between both sides in 3 groups,the results showed there was a negative correlation between all indexes except the height of ankle mortise and the Mazur score.No correlation was found between the height of ankle mortise and the Mazur score.Recovering the ankle mortise's width,depth,coronal angle as well as sagittal anglein the surgery of severe pilon fractures has a significant effect on ankle function.Conclusion Recovery of the ankle mortise's width,depth,coronal angle as welld as sagittal angle during the surgery of severe pilon fractures has a significant effect on ankle function,so the anatomy of the ankle mortise should be recovered as much as possible.