CAJ | 학술논문

目的：探讨跟骨外侧U形切口入路治疗跟骨骨折的临床疗效。方法采用跟骨外侧U形切口暴露治疗30例累及跟距关节、跟骰关节的单侧闭合跟骨骨折患者，术前术后测量B?hler角和Gissane角，按Maryland足部评分系统评价疗效。结果 B?hler角：术前-6°~20°(6．35°±10．34°)，术后3个月20°~36°(28．32°±5．29°)；Gissane角：术前71°~110°(89．76°±11．32°)，术后3个月112°~140°(122．45°±7．89°)；两项与术前比较差异均有统计学意义(P<0．01)。30例均获随访，时间9~23(14．23±2．23)个月。患者骨折均愈合，时间为8~11(9．2±1．5)周。关节面复位满意，跟骨高度恢复正常。无创伤性关节炎发生，无内固定物折断等相关并发症。术后34~80(46．2±8．98)周取出钢板。按Maryland足部评分系统评价疗效：优15例，良12例，中3例，优良率为90%。结论跟骨外侧U形切口能很好暴露骨折部位，利于恢复跟骨解剖形态，对累及跟距关节、跟骰关节的跟骨骨折疗效较好。
목적：탐토근골외측U형절구입로치료근골골절적림상료효。방법채용근골외측U형절구폭로치료30례루급근거관절、근투관절적단측폐합근골골절환자，술전술후측량B?hler각화Gissane각，안Maryland족부평분계통평개료효。결과 B?hler각：술전-6°~20°(6．35°±10．34°)，술후3개월20°~36°(28．32°±5．29°)；Gissane각：술전71°~110°(89．76°±11．32°)，술후3개월112°~140°(122．45°±7．89°)；량항여술전비교차이균유통계학의의(P<0．01)。30례균획수방，시간9~23(14．23±2．23)개월。환자골절균유합，시간위8~11(9．2±1．5)주。관절면복위만의，근골고도회복정상。무창상성관절염발생，무내고정물절단등상관병발증。술후34~80(46．2±8．98)주취출강판。안Maryland족부평분계통평개료효：우15례，량12례，중3례，우량솔위90%。결론근골외측U형절구능흔호폭로골절부위，리우회복근골해부형태，대루급근거관절、근투관절적근골골절료효교호。
Objective To explore effectiveness of lateral calcaneal U-shaped incision approach to treat calcaneal frac-tures. Methods 30 cases of calcaneal fractures involving the talocalcaneal and calcaneocuboid joints were treated by the lateral calcaneal U-shaped incision approach and calcaneal anatomical plate fixation. The angle of B?hler and Gis-sane were measured before and after the operation. The outcome of the treatment plan was evaluated after the opera-tion, according to the Maryland foot score system. Results The B?hler angles were -6° ~20°(6. 35° ± 10. 34°) before the surgery and 20°~36°(28. 32° ± 5. 29°) three months after the surgery. And Gissane angles were 71° ~110°(89. 76° ± 11. 32°) before the surgery and 112°~140°(122. 45° ± 7. 89°) three months after the surgery. The differences were significant (P<0. 01). 30 cases were followed up for 9~23(14. 23 ± 2. 23) months. X-ray showed patients healed, the healing time was 8~ 11(9. 2 ± 1. 5) weeks. Satisfactory reduction of the articular surface and calcaneal height, no traumatic arthritis and other internal fixation complications related fracture. The mean time of plate removal was (46. 2 ± 8. 98) weeks (range, 34~80 weeks). According to Maryland foot score, the results were excellent in 15 cases, good in 12 cases and fair in 3 cases;the excellent and good rate was 90%. Conclusions The lateral calcaneal U-shaped incision approach is an effective method to treat calcaneal fractures involving the talocalca-neal and calcaneocuboid joints, which can expose the fracture fully and restore the anatomy of the calcaneal bone.