CAJ | 학술논문

目的：比较切开复位钢板内固定（ORIF）和 ORIF加预防性距下关节融合术治疗 Sanders Ⅳ型跟骨骨折的临床疗效。方法54例 Sanders Ⅳ型跟骨骨折患者中，采用切开复位内固定24例（ORIF组），采用切开复位内固定加预防性距下关节融合术治疗30例（ORIF＋融合组）。观察手术后的Bohler’s角、Gissane’s角、跟骨宽度、跟骨轴长、跟骨丘部高度恢复及末次随访踝关节 Herr评分优良率。结果术后54例获24个月（6～48个月）随访。手术后Bohler’s角、Gissane’s 角、跟骨宽度、跟骨轴长、跟骨丘部高度的恢复，2组比较差异无统计学意义（P＞0．05）。末次随访踝关节 Herr评分优良率 ORIF组明显低于 ORIF＋融合组（62．5％比86．7％，P＜0．05）。结论切开复位内固定加预防性距下关节融合术治疗 Sanders Ⅳ型跟骨骨折疗效肯定，并发症较少，是治疗 Sanders Ⅳ型跟骨骨折的理想方法。
목적：비교절개복위강판내고정（ORIF）화 ORIF가예방성거하관절융합술치료 Sanders Ⅳ형근골골절적림상료효。방법54례 Sanders Ⅳ형근골골절환자중，채용절개복위내고정24례（ORIF조），채용절개복위내고정가예방성거하관절융합술치료30례（ORIF＋융합조）。관찰수술후적Bohler’s각、Gissane’s각、근골관도、근골축장、근골구부고도회복급말차수방과관절 Herr평분우량솔。결과술후54례획24개월（6～48개월）수방。수술후Bohler’s각、Gissane’s 각、근골관도、근골축장、근골구부고도적회복，2조비교차이무통계학의의（P＞0．05）。말차수방과관절 Herr평분우량솔 ORIF조명현저우 ORIF＋융합조（62．5％비86．7％，P＜0．05）。결론절개복위내고정가예방성거하관절융합술치료 Sanders Ⅳ형근골골절료효긍정，병발증교소，시치료 Sanders Ⅳ형근골골절적이상방법。
Objective To compare the efficacies of open reduction and internal fixation(ORIF) and ORIF combined with subtalar arthrodesis in the treatment of Sanders Ⅳ calcaneal fractures. Methods A total of 54 patients with SandersⅣ calcaneal fractures were treated with ORIF alone (ORIF group,n=24)or in combination with subtalar arthrodesis(ORIF+subtalar arthrodesis group,n=30).Bohler’s and Gissane’s angles and restoration of height,length,and width of the calcaneus were observed after operation.The excellent and good rate of Herr ankle score was re-corded at final follow-up.Results All patients were followed up for an average of 24 months (range 6 to 48 months).There were no significant differences in Bohler’s and Gissane’s angles and restoration of height,length,and width of the calcaneus between the two groups(P>0.05). Compared with ORIF+subtalar arthrodesis group,the excellent and good rate of Herr ankle score significantly decreased in ORIF group at final follow-up(86.7% vs 62.5%,P<0.05).Conclusion ORIF combined with subtalar arthrodesis is an effective and ideal method and can reduce the occurrence of complications in the treatment of Sanders Ⅳ calcaneal fractures.