CAJ | 학술논문

目的观察采用一期彻底清创、经伤口复位、克氏针经皮穿距下关节内固定的方法治疗GustiloⅡ、ⅢA型开放性跟骨骨折的疗效.方法自2009年5月至2012年10月手术治疗开放性跟骨骨折19例,男17例,女2例;年龄31 ～ 60岁,平均39.6岁;骨折按Gustilo分型:Ⅱ型8例,ⅢA型11例;按Sanders分型:Ⅱ型3例,Ⅲ型12例,Ⅳ型4例.将跟骨内侧伤口一期彻底清创,经伤口复位,然后采用克氏针经皮穿距下关节进行内固定.伤口均不一期缝合,待伤口肉芽组织充填后二期游离植皮覆盖创面,必要时行腓肠神经营养皮瓣转移充填软组织缺损.测量并比较手术前、后跟骨B(o)hler角、Gissane角、高度、宽度.结果所有患者术后随访14～ 26个月(平均16.8个月).5例患者发生浅表感染经换药后治愈,无皮肤坏死、深部感染、骨不连、骨髓炎等并发症或截肢.12例患者解剖复位,7例患者接近解剖复位.所有患者的跟骨B(o)hler角、Gissane角、跟骨高度、跟骨宽度恢复满意,与术前比较差异均有统计学意义(P＜0.05).术后1年采用美国足踝外科协会踝与后足评分评估疗效:优9例,良7例,可2例,差1例.结论一期彻底清创、经伤口复位、克氏针经皮穿距下关节内固定是治疗GustiloⅡ、ⅢA型开放性跟骨骨折的一种有效方法.
목적 관찰채용일기철저청창、경상구복위、극씨침경피천거하관절내고정적방법치료GustiloⅡ、ⅢA형개방성근골골절적료효.방법 자2009년5월지2012년10월수술치료개방성근골골절19례,남17례,녀2례;년령31 ～ 60세,평균39.6세;골절안Gustilo분형:Ⅱ형8례,ⅢA형11례;안Sanders분형:Ⅱ형3례,Ⅲ형12례,Ⅳ형4례.장근골내측상구일기철저청창,경상구복위,연후채용극씨침경피천거하관절진행내고정.상구균불일기봉합,대상구육아조직충전후이기유리식피복개창면,필요시행비장신경영양피판전이충전연조직결손.측량병비교수술전、후근골B(o)hler각、Gissane각、고도、관도.결과 소유환자술후수방14～ 26개월(평균16.8개월).5례환자발생천표감염경환약후치유,무피부배사、심부감염、골불련、골수염등병발증혹절지.12례환자해부복위,7례환자접근해부복위.소유환자적근골B(o)hler각、Gissane각、근골고도、근골관도회복만의,여술전비교차이균유통계학의의(P＜0.05).술후1년채용미국족과외과협회과여후족평분평고료효:우9례,량7례,가2례,차1례.결론 일기철저청창、경상구복위、극씨침경피천거하관절내고정시치료GustiloⅡ、ⅢA형개방성근골골절적일충유효방법.
Objective To assess the operative treatment of open calcaneal fractures of Gustilo types Ⅱ and Ⅲ A by urgent debridement,reduction through the open wound,immediate fixation by percutaneous transarticular k-wire and delayed wound closure.Methods From May 2009 to October 2012,19 cases of open calcaneal fractures were treated according to the same operative protocol.They were 17 men and 2 women,aged from 31 to 60 years (average,39.6 years).By Gustilo classification,8 cases were of type Ⅱ and 11 of type ⅢA.By Sanders classification,there were 3 cases of type Ⅱ,12 ones of type Ⅲ and 4 ones of type Ⅳ.After intravenous administration of antibiotics,urgent debridement and reduction through the open wound under the C-arm inspection,the sinus tarsi approach was used when necessary.Percutaneous K-wire fixation was conducted through the posterior facet,and the wound was left open or covered with VSD.The soft tissue coverage was delayed until application of a split-thickness skin graft or pedicle flap transfer.Before and after operation,axial and lateral X-ray radiography and axial,semi-coronal and sagittal CT of the heel were performed.The width,height,B(o)hler's angle and Gissane's angle were compared between preoperation and postoperation.Clinical results were graded according to the AOFAS (American Orthopaedic Foot and Ankle Society) scoring one year postoperation.Results All the 19 patients were available for an average follow-up of 16.8 months (from 14 to 26 months).Superficial infection occurred in 5 patients but was cured after dressing change.No skin necrosis,deep infection,bone nonunion,osteomyelitis or amputation occurred.Reduction of the posterior facet was graded as anatomical in 12 cases and as nearly anatomical in 7 cases.The width,height,B(o)hler's and Gissane's angles were improved significantly in all patients (P ＜ 0.05).By the AOFAS ankle-hindfoot scores,9 cases were excellent,7 good,2 moderate and one poor.Conclusion The surgical protocol of urgent debridement,reduction through the open wound,immediate fixation by percutaneous transarticular k-wire and delayed wound closure is an ideal treatment of open calcaneal fractures of Gustilo types Ⅱ and Ⅲ A.