CAJ | 학술논문

目的探讨跟骨结节撕脱骨折的治疗方法及疗效.方法回顾性分析2008年1月至2011年6月治疗15例跟骨结节撕脱骨折患者资料,男9例,女6例；年龄31～68岁,平均51.4岁；均为单侧急性损伤,左足7例,右足8例.根据Beavis分型:Ⅰ型3例,均采用切开复位螺钉固定；Ⅱ型12例,其中10例采用切开复位螺钉固定,2例骨折块较大累及部分距下关节面者采用钢板加螺钉固定.采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分系统评价术后疗效.结果 10例患者获得随访,随访时间12～36个月,平均20个月.骨折愈合时间为8～25周,平均13周.术后AOFAS踝与后足评分为47～100分,平均91.1分；优7例,良2例,差1例,优良率为90％(9/10).1例术后8周出现皮肤软组织坏死、钢板外露患者,行保留钢板的清创加腓动脉穿支皮瓣移植术后3周切口愈合；1例术后7周复位丢失患者,再次行切开复位螺钉内固定,于初次术后25周骨折愈合.结论对骨折块移位明显,软组织严重激惹者,应急诊行切开复位内固定手术,防止皮瓣坏死；对骨折块较小者,应采用切开复位大直径螺钉固定；对骨折块较大者,尤其当骨折线延伸至部分距下关节面时,应采用钢板加螺钉固定.
목적 탐토근골결절시탈골절적치료방법급료효.방법 회고성분석2008년1월지2011년6월치료15례근골결절시탈골절환자자료,남9례,녀6례；년령31～68세,평균51.4세；균위단측급성손상,좌족7례,우족8례.근거Beavis분형:Ⅰ형3례,균채용절개복위라정고정；Ⅱ형12례,기중10례채용절개복위라정고정,2례골절괴교대루급부분거하관절면자채용강판가라정고정.채용미국족과외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)과여후족평분계통평개술후료효.결과 10례환자획득수방,수방시간12～36개월,평균20개월.골절유합시간위8～25주,평균13주.술후AOFAS과여후족평분위47～100분,평균91.1분；우7례,량2례,차1례,우량솔위90％(9/10).1례술후8주출현피부연조직배사、강판외로환자,행보류강판적청창가비동맥천지피판이식술후3주절구유합；1례술후7주복위주실환자,재차행절개복위라정내고정,우초차술후25주골절유합.결론 대골절괴이위명현,연조직엄중격야자,응급진행절개복위내고정수술,방지피판배사；대골절괴교소자,응채용절개복위대직경라정고정；대골절괴교대자,우기당골절선연신지부분거하관절면시,응채용강판가라정고정.
Objective To discuss the operative methods and cnrative effect of calcaneal tuberosity fracture.Methods The data of 15 patients with calcaneal tuberosity fracture was retrospectively analyzed who received treatment between January 2008 and June 2011.There were 9 males and 6 female,with the age ranging from 31 to 68 years (average,51.4 years).All the patients had unilateral acute injury,with the left foot in 7 cases and the right foot in 8 cases.According to the Beavis classification,there were 3 cases in type Ⅰ and 12 cases in type Ⅱ.All the cases in type Ⅰ and 10 cases in type Ⅱ were treated with open reduction and screw fixation.The other 2 cases in type Ⅱ with larger fragment involving a portion of the subtalar joint were treated with plate and screw fixation.The effect of the treatment was assessed according to the ankle and hindfoot score system of American Orthopaedic Foot and Ankle Society (AOFAS) after the operation.Results Ten patients were followed up for 12 to 36 months (average,20 months).The healing time in these patients ranged from 8 to 25 weeks (average,12 weeks).The postoperative score ranged from 47 to 100 points (average,91.1 points).There were 7 cases which received excellent effect,2 cases,good,and 1 case,poor.The rate of excellent and good was 90％.Necrosis of skin and soft tissue and exposure of the plate happened to one patient,who eventually healed after 3 weeks by debridement with plate preserved and peroneal artery perforator flap transplantation.Loss of reduction happened to another patient,who was treated with the revision surgery by open reduction and screw fixation again.Conclusion To patients with obvious Fracture displacement whose soft tissues are irritated severely.Emergency open reduction and internal fixation operation should be offered to prevent the necrosis of the flaps as far as possible.To patients with small fractures,it is advisable to choose open reduction and large diameter screw fixation,while plate and screw fixation may be better for patients with larger tuberosity fragment,especially when the fracture line extends to the facet of the subtalar joint.