CAJ | 학술논문

目的：对经跗骨窦小切口和跟骨外侧“L”型切口治疗跟骨骨折两种方式进行疗效及并发症比较研究。方法对2008年7月至2013年7月间本院收治的跟骨骨折患者48例56足手术治疗,分为经跗骨窦小切口组( A组)和“L 型”切口组( B组)。 A组SandersⅡ型18足,SandersⅢ型7足；B组SandersⅡ型9足,SandersⅢ型22足。小切口手术方法采用经跗骨窦小切口,先外侧小切口直视下复位距下关节,复位后经跗骨窦切口行螺钉固定术；“L”型切口手术方法采用标准切口,直视下复位距下关节面,复位后以跟骨锁定钢板固定。术后随访评分参照美国骨科足与踝关节协会的足踝临床后足评分系统( AOFAS)观察跟骨宽度、高度、Bolher 角及 Gissane 角。结果术后所有病例均获得随访,平均随访时间15个月(9~48个月),术后两组Bolher 角及 Gissane角较术前有明显好转,差异有统计学意义(P<0．05),两组间差异均无统计学意义(P>0．05)。 Sanders Ⅱ型跟骨骨折A组与B组相比术后AOFAS评分差异有统计学意义(P<0．05), Sanders Ⅲ型跟骨骨折A组与B组差异无统计学意义( P>0．05)。 Sanders Ⅲ型跟骨骨折术后 AOFAS 评分(74．4±6．7)分明显低于 Sanders Ⅱ型跟骨骨折评分(84．6±4．3)分,差异有统计学意义(P<0．05)。结论采用经附骨窦小切口切开治疗SandersⅡ型跟骨骨折,其疗效确切,并发症明显降低。
목적：대경부골두소절구화근골외측“L”형절구치료근골골절량충방식진행료효급병발증비교연구。방법대2008년7월지2013년7월간본원수치적근골골절환자48례56족수술치료,분위경부골두소절구조( A조)화“L 형”절구조( B조)。 A조SandersⅡ형18족,SandersⅢ형7족；B조SandersⅡ형9족,SandersⅢ형22족。소절구수술방법채용경부골두소절구,선외측소절구직시하복위거하관절,복위후경부골두절구행라정고정술；“L”형절구수술방법채용표준절구,직시하복위거하관절면,복위후이근골쇄정강판고정。술후수방평분삼조미국골과족여과관절협회적족과림상후족평분계통( AOFAS)관찰근골관도、고도、Bolher 각급 Gissane 각。결과술후소유병례균획득수방,평균수방시간15개월(9~48개월),술후량조Bolher 각급 Gissane각교술전유명현호전,차이유통계학의의(P<0．05),량조간차이균무통계학의의(P>0．05)。 Sanders Ⅱ형근골골절A조여B조상비술후AOFAS평분차이유통계학의의(P<0．05), Sanders Ⅲ형근골골절A조여B조차이무통계학의의( P>0．05)。 Sanders Ⅲ형근골골절술후 AOFAS 평분(74．4±6．7)분명현저우 Sanders Ⅱ형근골골절평분(84．6±4．3)분,차이유통계학의의(P<0．05)。결론채용경부골두소절구절개치료SandersⅡ형근골골절,기료효학절,병발증명현강저。
Objective To compare the results and complication between minimally invasive and L incision approach of calcaneus fracture. Methods Total 48 patients with calcaneus fracture were enrolled in the study from Jul. 2008 to Jul. 2013. There were 27 case of SandersⅡand 29 cases of SandersⅢ. Group A was defined as minimally invasive approach and group B was defined as L incision approach. There were 18 cases of SandersⅡin group A and 9 cases in group B. There were 7 cases of SandersⅢ in group A and 22 cases in group B,respectively. In group A the minimally invasive and hollow screws were used and in group B plate with L incision were performed. The Bolher and Gissane angles were evaluated and final results were analyzed. AOFAS e-valuation was performed in every patient. Results The average follow up time was 15 months( range 9~48 months) . There was no significant difference of Bolher and Gissane angles between groups A and B(P>0. 05). And we got better results after operation than preoperative angles in two groups(P<0. 05). The average AOFAS of SandersⅡin group A higher than that of group B(P<0. 05). There was no significant difference of AOFAS of SandersⅢbetween two groups. AOFAS of SandersⅢwas higher than that of SandersⅡ(P<0. 05). One case with surface infection was found in group A. There were 6 cases with deep infection and two of them suffered osteomyelitis,and 4 patients of them healed with transfer of skin flap. Conclusion The minimally invasive approach to treat SandersⅡcalcaneus fracture got better result than traditional L incision approach. However the results of SandersⅢcalcane-us fracture had no significant difference between minimally invasive and L incision approach.