中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
3期
240-244
,共5页
陈文%边竟%关韶勇%陈廖斌%吴志勇%张江%谢易%刘小涛%孙景东%王平年%卢云%龚泰芳%王达义%易显富
陳文%邊竟%關韶勇%陳廖斌%吳誌勇%張江%謝易%劉小濤%孫景東%王平年%盧雲%龔泰芳%王達義%易顯富
진문%변경%관소용%진료빈%오지용%장강%사역%류소도%손경동%왕평년%로운%공태방%왕체의%역현부
外固定器%跟骨%骨折
外固定器%跟骨%骨摺
외고정기%근골%골절
External fixators%Calcaneus%Fractures
目的 探讨自行研制的跟骨外固定器治疗跟骨关节内骨折的临床效果.方法 回顾性分析2006年5月至2009年5月收治的30例跟骨关节内骨折患者的病例,男20例,女10例；年龄15～53岁,平均36岁.根据Sanders等分型,Ⅲ型16例,Ⅳ型14例.先应用自行研制的跟骨外固定器初步进行跟骨骨折的大体复位和固定,然后通过跟骨外侧小切口充分暴露并精确复位跟骨的后关节面.比较术前、术后3d及术后6个月在跟骨侧位及轴位X线片上测得的跟骨长度、宽度、丘部高度、后关节面最大垂直移位、B(o)hler角的变化.根据Buckley标准,通过CT扫描评估后关节面复位情况.结果 所有患者均获得随访,随访时间4～45个月,平均29个月.术后3d和术后6个月时患侧跟骨侧位及轴位X线片示上述跟骨的解剖结构基本恢复至正常范围,并分别与术前比较,差异均有统计学意义；术后6个月与术后3d比较,差异无统计学意义.末次随访时CT扫描示后关节面解剖复位27例,关节面不平整≤2 mm者3例.结论 此跟骨外固定器治疗跟骨关节内骨折疗效确切,具有微创、实用、并发症少的特点.
目的 探討自行研製的跟骨外固定器治療跟骨關節內骨摺的臨床效果.方法 迴顧性分析2006年5月至2009年5月收治的30例跟骨關節內骨摺患者的病例,男20例,女10例；年齡15～53歲,平均36歲.根據Sanders等分型,Ⅲ型16例,Ⅳ型14例.先應用自行研製的跟骨外固定器初步進行跟骨骨摺的大體複位和固定,然後通過跟骨外側小切口充分暴露併精確複位跟骨的後關節麵.比較術前、術後3d及術後6箇月在跟骨側位及軸位X線片上測得的跟骨長度、寬度、丘部高度、後關節麵最大垂直移位、B(o)hler角的變化.根據Buckley標準,通過CT掃描評估後關節麵複位情況.結果 所有患者均穫得隨訪,隨訪時間4～45箇月,平均29箇月.術後3d和術後6箇月時患側跟骨側位及軸位X線片示上述跟骨的解剖結構基本恢複至正常範圍,併分彆與術前比較,差異均有統計學意義；術後6箇月與術後3d比較,差異無統計學意義.末次隨訪時CT掃描示後關節麵解剖複位27例,關節麵不平整≤2 mm者3例.結論 此跟骨外固定器治療跟骨關節內骨摺療效確切,具有微創、實用、併髮癥少的特點.
목적 탐토자행연제적근골외고정기치료근골관절내골절적림상효과.방법 회고성분석2006년5월지2009년5월수치적30례근골관절내골절환자적병례,남20례,녀10례；년령15～53세,평균36세.근거Sanders등분형,Ⅲ형16례,Ⅳ형14례.선응용자행연제적근골외고정기초보진행근골골절적대체복위화고정,연후통과근골외측소절구충분폭로병정학복위근골적후관절면.비교술전、술후3d급술후6개월재근골측위급축위X선편상측득적근골장도、관도、구부고도、후관절면최대수직이위、B(o)hler각적변화.근거Buckley표준,통과CT소묘평고후관절면복위정황.결과 소유환자균획득수방,수방시간4～45개월,평균29개월.술후3d화술후6개월시환측근골측위급축위X선편시상술근골적해부결구기본회복지정상범위,병분별여술전비교,차이균유통계학의의；술후6개월여술후3d비교,차이무통계학의의.말차수방시CT소묘시후관절면해부복위27례,관절면불평정≤2 mm자3례.결론 차근골외고정기치료근골관절내골절료효학절,구유미창、실용、병발증소적특점.
Objective To evaluate the clinical results of indirect reduction and fixation with the self-manufactured external fixator as a viable alternative in the surgical treatment of intraarticular calcaneal fractures.Methods From May 2006 to May 2009,a total of 30 patients undergone surgical treatment of intraarticular calcaneal fractures were analyzed,including 20 males and 10 females with an average age of 36 years (range,15-53).According to Sanders classification based on the computed tomography scan of intraarticular calcaneal fractures,16 patients were classified as type-Ⅲ,and 14 type-Ⅳ in this series.All fractures were treated first with the external fixator as indirect reduction and fixation device on the whole,which can enlarge the interspace of the subtalar joint significantly.Then,posterior articular facet of calcaneus was exposed and reduced through a small lateral incision.The calcaneal's length,breadth,thalamus height,maximum vertical displacement of the post-articular surface,and B(o)hler angle were measured preoperatively,3 days and 6 months after operation in X-ray film.Reduction results were evaluated by CT scan according to the standard of Buckley.Results The average follow-up time of all patients was 29 months (range,4-45).Lateral and axial roentgenograms showed satisfactory restoration of the calcaneal's anatomical structure.There were significant differences between preoperative values and those 3 days or 6 months postoperatively.There were no significant differences between values 3 days postoperatively and those 6 months postoperatively.The reduction results of posterior articular facet were evaluated by CT scan.Twenty-seven patients obtained anatomical reduction,3 patients obtained uneven articular facet within 2 mm.Conclusion This selfmanufactured external fixator is a vialbe alternative in the treatment of intraarticular calcaneal fractures,which has advantages of minimal invasion,practicality and less complications.
