CAJ | 학술논문

目的：探讨切开复位固定、不植骨治疗Sanders Ⅲ、Ⅳ型跟骨骨折的手术方法及疗效。方法2008年1月～2011年11月，应用跟骨外侧手术入路、切开复位解剖钢板固定、不植骨治疗跟骨粉碎性骨折66例、77足。其中男45例，女21例，11例为双侧。年龄22～55岁，平均37岁。根据Sanders分型，Ⅲ型17足，Ⅳ型60足。结果本组66例患者均获随访，获随访12～18个月，平均15个月。77足切口均Ⅰ期愈合，随访中无螺钉退出、断裂等现象。除5例合并股骨骨折的的病例，其余半年后均能正常行走。术前Bǒhler’ s 角（4.6°±6.2°），术后（31.6°±7.4°）；术前 Gissane’ s 角（158.12°±8.57°），术后（136.58°±6.85°），各指标手术前后比较差异有统计学意义。按Maryland足部评分系统评价术后功能，本组77足中，优（90～100分）68足，良（75～89分）8足。可（50～74分）1足，优良率98.7％。结论通过本方法治疗跟骨骨折，能够良好的维持跟骨的解剖形态，足的功能恢复满意，且明显降低了植骨术后的排异反应及切口不愈合的发生，有效的减轻了患者的痛苦和经济负担。
목적：탐토절개복위고정、불식골치료Sanders Ⅲ、Ⅳ형근골골절적수술방법급료효。방법2008년1월～2011년11월，응용근골외측수술입로、절개복위해부강판고정、불식골치료근골분쇄성골절66례、77족。기중남45례，녀21례，11례위쌍측。년령22～55세，평균37세。근거Sanders분형，Ⅲ형17족，Ⅳ형60족。결과본조66례환자균획수방，획수방12～18개월，평균15개월。77족절구균Ⅰ기유합，수방중무라정퇴출、단렬등현상。제5례합병고골골절적적병례，기여반년후균능정상행주。술전Bǒhler’ s 각（4.6°±6.2°），술후（31.6°±7.4°）；술전 Gissane’ s 각（158.12°±8.57°），술후（136.58°±6.85°），각지표수술전후비교차이유통계학의의。안Maryland족부평분계통평개술후공능，본조77족중，우（90～100분）68족，량（75～89분）8족。가（50～74분）1족，우량솔98.7％。결론통과본방법치료근골골절，능구량호적유지근골적해부형태，족적공능회복만의，차명현강저료식골술후적배이반응급절구불유합적발생，유효적감경료환자적통고화경제부담。
Objective To study the effects of open reduction and internal fixation ( ORIF) without bone graft for type Ⅲand type Ⅳcalcaneal fractures .Methods 66 cases ( including 51 feet in 45 males and 26 feet in 21 females, aged from 22 to 55) of calcaneal fractures were enrolled from January 2008 to November 2011.According to Sanders ’ classification, 17 cases were classified as type Ⅲ and 60 cases were type Ⅳ.All the patients underwent open reduction through the lateral extensile incision and the internal fixation without bone graft .Results All the cases treated surgically were followed up for 12-18 months (average 15months).77 feet achieved primary healing.No backing out or fracture of the screw occured.Except five patients who combined with the femoral fracture , all the other patients were able to walk properly six months after the surgery .The preoperative X-ray examination showed that Bǒhler angle was (4.6°±6.2°) and Gissane angle was (158.12°±8.57°); the postoperative X -ray examination demonstrated that Bǒhler angle was (31.6°±7.4°) and Gissane angle was (136.58°±6.85°); there were statistically significant diffrerences .According to the Maryland evaluation system for foot , 68 feet scored 90-100 points, eight feet scored 75-89 points and one foot scored 50-74 points.The excellent rate was 98.7%.Conclusions Open reduction and internal fixation without bone graft is an effective method to treat the calcaneus fracture .The technique may contribute to maintaining the anatomical shape of calcaneus and the foot function recovery .It can significantly reduce the incidence of non -healing of the wound and relieve the suffering and economic burden of the patient .