CAJ | 학술논문

目的探讨切开复位内固定治疗跟骨关节内骨折术后载距突的固定情况及其对临床疗效的影响. 方法回顾性分析2008年4月-2012年1月切开复位内固定治疗的139例跟骨关节内骨折患者的资料.根据Sanders分型:Ⅱ型9例,Ⅲ型87例,Ⅳ型43例.采用跟骨外侧“L”形切口,骨折复位后应用跟骨解剖型钢板或解剖锁定钢板固定.术后2周内摄X线片和CT扫描,采用CT容积重建法的内置入物显像结合多平面重组成像(multiplanar reconstruction,MPR)模式对载距突固定情况进行观察.根据影像学检查结果将患者分为载距突有效固定组(A组,28例)、边缘固定组(B组,58例)、未固定组(C组,53例).比较3组患者术中及围术期相关特征、术后部分负重时间、完全负重时间、骨折愈合时间及临床疗效.采用美国足踝外科协会(American Orthopedic Foot&Ankle Society,AOFAS)踝后足评分标准进行功能评分. 结果术后X线片示64例载距突获得有效固定,22例为边缘固定,53例未固定.但CT图像显示有效固定仅28例,边缘固定58例,未固定53例.A组手术时间[(93±11)min]和术中出血量[(252±27)ml]均大于B组[(85±8)min、(194±16)ml]和C组[(57 ±6) min、(136±13)ml] (P ＜0.05),3组患者平均住院时间差异无统计学意义(P＞0.05).92例患者获随访12～38个月,平均18.5个月,其中85例能按预设康复计划完成足踝功能锻炼.3组患者术后部分和完全负重时间、X线骨折愈合时间、末次随访时AOFAS评分结果差异均无统计学意义(P＞0.05). 结论切开复位内固定治疗跟骨骨折后载距突螺钉固定情况对短期临床疗效无明显影响.
목적 탐토절개복위내고정치료근골관절내골절술후재거돌적고정정황급기대림상료효적영향. 방법 회고성분석2008년4월-2012년1월절개복위내고정치료적139례근골관절내골절환자적자료.근거Sanders분형:Ⅱ형9례,Ⅲ형87례,Ⅳ형43례.채용근골외측“L”형절구,골절복위후응용근골해부형강판혹해부쇄정강판고정.술후2주내섭X선편화CT소묘,채용CT용적중건법적내치입물현상결합다평면중조성상(multiplanar reconstruction,MPR)모식대재거돌고정정황진행관찰.근거영상학검사결과장환자분위재거돌유효고정조(A조,28례)、변연고정조(B조,58례)、미고정조(C조,53례).비교3조환자술중급위술기상관특정、술후부분부중시간、완전부중시간、골절유합시간급림상료효.채용미국족과외과협회(American Orthopedic Foot&Ankle Society,AOFAS)과후족평분표준진행공능평분. 결과 술후X선편시64례재거돌획득유효고정,22례위변연고정,53례미고정.단CT도상현시유효고정부28례,변연고정58례,미고정53례.A조수술시간[(93±11)min]화술중출혈량[(252±27)ml]균대우B조[(85±8)min、(194±16)ml]화C조[(57 ±6) min、(136±13)ml] (P ＜0.05),3조환자평균주원시간차이무통계학의의(P＞0.05).92례환자획수방12～38개월,평균18.5개월,기중85례능안예설강복계화완성족과공능단련.3조환자술후부분화완전부중시간、X선골절유합시간、말차수방시AOFAS평분결과차이균무통계학의의(P＞0.05). 결론 절개복위내고정치료근골골절후재거돌라정고정정황대단기림상료효무명현영향.
Objective To investigate the effect of sustentaculum tali screw placement on outcomes following open reduction and internal fixation (ORIF) of intraarticular calcaneal fractures.Methods A retrospective analysis was made on 139 patients with intraarticular calcaneal fractures treated by ORIF from April 2008 to January 2012.According to Sanders classification,there were 9 patients with type Ⅱ fractures,87 with type Ⅲ fractures and 43 with type Ⅳ fractures.Fracture reduction followed by placement of calcaneal anatomic plate or anatomic locking plate was performed via calcaneal lateral L-shape incision.All the patients received X-rays and CT scans within postoperative 2 weeks.Placement of screws in sustentaculum tail was detected by CT volume rendering to visualize implants combined with multiplanar reconstruction imaging (MPR).Patients were divided into accurate fixation group (Group A,n =28),marginal fixation group (Group B,n =58),and non-fixation group (Group C,n =53) based on radiological results.Intra-and peri-operative parameters,time to partial weight-bearing,time to full weight-bearing,fracture healing time,and clinical outcome were compared among groups.Functional outcome was assessed using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale.Results Postoperative X-rays indicated accurate fixation of sustentaculum tail in 64 patients,marginal fixation in 22,and non-fixation in 53,but CT images manifested accurate fixation in 28 patients,marginal fixation in 58,and non-fixation in 53.Group A had operation duration of (93 ±11) min and intraoperative blood loss of (252 ± 27) ml,longer or higher than those in Group B [(85 ±8) min,(194±16) ml] and Group C [(57±6) min,(136 ±13) ml] (P＜O.05).There was no significant difference in mean hospital stay among the three groups (P ＞ 0.05).Ninety-two patients were followed-up for 12-38 months (mean 18.5 months) and 85 patients completed foot and ankle exercise as planned.Moreover,no significant differences were observed among groups concerning time to partial and full weight-bearing,fracture healing time and AOFAS score at the final follow-up (P ＞ 0.05).Conclusion Sustentaculum tali screw placement has no apparent effect on the short-term outcome of surgical treatment for calcaneal fractures.