中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
35期
5627-5632
,共6页
李广峰%吴献民%王思成%杨国庆%张友忠%曹中华%何国云%尹志峰%杨笑宇%张鑫%彭勇
李廣峰%吳獻民%王思成%楊國慶%張友忠%曹中華%何國雲%尹誌峰%楊笑宇%張鑫%彭勇
리엄봉%오헌민%왕사성%양국경%장우충%조중화%하국운%윤지봉%양소우%장흠%팽용
植入物%骨植入物%跟骨%粉碎性骨折%后上方骨折%钢板螺钉%斯氏针
植入物%骨植入物%跟骨%粉碎性骨摺%後上方骨摺%鋼闆螺釘%斯氏針
식입물%골식입물%근골%분쇄성골절%후상방골절%강판라정%사씨침
calcaneus%fractures,comminuted%internal fixators%fol ow-up studies
背景：目前跟骨关节内粉碎性骨折的治疗方案一般选择钢板螺钉内固定，但对于伴有跟骨后上方骨折的病例，往往因为跟腱牵拉及钢板螺钉内固定的薄弱导致骨折复位困难或者复位难以保持。目的：探讨切开复位钢板螺钉结合斯氏针置入内固定在粉碎性跟骨关节内移位骨折伴后上方骨折中的疗效。方法：选取2009年12月至2013年12月上海中冶医院骨科收治的粉碎性跟骨关节内骨折伴跟骨后上方骨折患者40例，随机分为2组。对照组予切开复位钢板螺钉内固定，试验组予切开复位钢板螺钉结合斯氏针内固定。分别于术前、术后4周测量患者GISSANE角、BOHLER角，末次随访时进行MARYLAND足部评分，并进行组内及组间比较。结果与结论：所有患者均获随访，时间9-23个月。两组患者术后4周BOHLER角、GISSANE角均显著大于术前(P <0.05)；术后4周试验组BOHLER角、GISSANE角均显著大于对照组(P <0.05)。末次随访时MARYLAND足部评分试验组平均78分，优良率为80%；对照组平均67分，优良率为73%，试验组优良率显著高于对照组(P<0.05)。提示钢板螺钉内固定辅助斯氏针置入固定修复粉碎性跟骨骨折伴有跟骨后上方骨折，可较单纯钢板螺钉置入内固定取得更为满意的关节内骨折及后上方骨折复位，固定牢靠，可早期功能锻炼，术后患肢功能恢复较单纯钢板螺钉内固定较好。
揹景：目前跟骨關節內粉碎性骨摺的治療方案一般選擇鋼闆螺釘內固定，但對于伴有跟骨後上方骨摺的病例，往往因為跟腱牽拉及鋼闆螺釘內固定的薄弱導緻骨摺複位睏難或者複位難以保持。目的：探討切開複位鋼闆螺釘結閤斯氏針置入內固定在粉碎性跟骨關節內移位骨摺伴後上方骨摺中的療效。方法：選取2009年12月至2013年12月上海中冶醫院骨科收治的粉碎性跟骨關節內骨摺伴跟骨後上方骨摺患者40例，隨機分為2組。對照組予切開複位鋼闆螺釘內固定，試驗組予切開複位鋼闆螺釘結閤斯氏針內固定。分彆于術前、術後4週測量患者GISSANE角、BOHLER角，末次隨訪時進行MARYLAND足部評分，併進行組內及組間比較。結果與結論：所有患者均穫隨訪，時間9-23箇月。兩組患者術後4週BOHLER角、GISSANE角均顯著大于術前(P <0.05)；術後4週試驗組BOHLER角、GISSANE角均顯著大于對照組(P <0.05)。末次隨訪時MARYLAND足部評分試驗組平均78分，優良率為80%；對照組平均67分，優良率為73%，試驗組優良率顯著高于對照組(P<0.05)。提示鋼闆螺釘內固定輔助斯氏針置入固定脩複粉碎性跟骨骨摺伴有跟骨後上方骨摺，可較單純鋼闆螺釘置入內固定取得更為滿意的關節內骨摺及後上方骨摺複位，固定牢靠，可早期功能鍛煉，術後患肢功能恢複較單純鋼闆螺釘內固定較好。
배경：목전근골관절내분쇄성골절적치료방안일반선택강판라정내고정，단대우반유근골후상방골절적병례，왕왕인위근건견랍급강판라정내고정적박약도치골절복위곤난혹자복위난이보지。목적：탐토절개복위강판라정결합사씨침치입내고정재분쇄성근골관절내이위골절반후상방골절중적료효。방법：선취2009년12월지2013년12월상해중야의원골과수치적분쇄성근골관절내골절반근골후상방골절환자40례，수궤분위2조。대조조여절개복위강판라정내고정，시험조여절개복위강판라정결합사씨침내고정。분별우술전、술후4주측량환자GISSANE각、BOHLER각，말차수방시진행MARYLAND족부평분，병진행조내급조간비교。결과여결론：소유환자균획수방，시간9-23개월。량조환자술후4주BOHLER각、GISSANE각균현저대우술전(P <0.05)；술후4주시험조BOHLER각、GISSANE각균현저대우대조조(P <0.05)。말차수방시MARYLAND족부평분시험조평균78분，우량솔위80%；대조조평균67분，우량솔위73%，시험조우량솔현저고우대조조(P<0.05)。제시강판라정내고정보조사씨침치입고정수복분쇄성근골골절반유근골후상방골절，가교단순강판라정치입내고정취득경위만의적관절내골절급후상방골절복위，고정뢰고，가조기공능단련，술후환지공능회복교단순강판라정내고정교호。
BACKGROUND:The therapeutic regimen of intraarticular calcaneal comminuted fractures commonly selects plate and screw fixation. However, for case of posterosuperior calcaneal fracture, the weakness of achil es tendon stretch and plate screw fixation results in difficulty or maintenance of reduction. OBJECTIVE:To investigate the therapeutic effects of open reduction and internal fixation with steel screw and Steinmann pins for comminuted calcaneal intra-articular and posterosuperior fractures. METHODS:From December 2009 to December 2013, forty patients with fractures of comminuted calcaneal posterosuperior fractures were randomly divided into two groups. In the control group, patients were treated by open reduction and internal fixation by plate screw only. In the experimental group, patients were treated by open reduction and internal fixation by combination of plate screw and Steinmann pin. The Gissane and Bohler angles of the calcaneus were measured from lateral radiograph before and 4 weeks after surgery, and the MARYLAND score was assessed at the last fol ow-up. Gissane and Bohler angle and MARYLAND score were compared in each group and among different groups. RESULTS AND CONCLUSION:Al patients were fol owed up for 9-23 months. BOHLER and GISSANE angles were significantly bigger at 4 weeks after surgery compared with pre-treatment in both groups (P<0.05). BOHLER and GISSANE angles were significantly bigger in the experimental group than in the control group at 4 weeks after surgery (P<0.05). During final fol ow-up, the average score by MARYLAND Foot Score was 78 in the experimental group and 67 in control group, with their excellent and good rate of 80%and 73%. The excellent and good rate was significantly higher in the experimental group than in the control group (P<0.05). These data indicated that open reduction and internal fixation with combination of plate screw and Steinmann pin has better efficacy in treatment of the comminuted calcaneal intra-articular and posterosuperior fractures compared with plate and screw fixation alone. Their fixation is firm. Functional exercise can be performed earlier. Postoperative recovery of function of the affected limbs is better than plate and screw fixation alone.
