CAJ | 학술논문

目的探讨距骨合并同侧跟骨骨折的临床特征及治疗效果.方法 2003年4月至2011年7月收治距骨合并同侧跟骨骨折患者22例,男20例,女2例;年龄17～51岁,平均30.2岁;右侧12例,左侧10例.致伤原因:高处坠落伤13例,交通事故伤5例,重物砸伤4例.距骨颈骨折8例:Hawkins分型Ⅰ型3例、Ⅱ型3例、Ⅲ型2例;距骨体骨折14例:Sneppen分型Ⅱ型6例、Ⅲ型2例、V型6例.跟骨关节外骨折13例:跟骨前突骨折5例、跟骨结节骨折2例、载距突骨折3例、跟骨体骨折3例;关节内骨折9例:Essex-Lopresti分型塌陷骨折7例、舌形骨折2例.开放性骨折4例,Gustilo和Anderson分型Ⅰ型1例、Ⅱ型2例、ⅢA型1例.开放性骨折于伤后平均5.5 h手术,闭合性骨折于伤后平均第11天手术.采用内固定手术治疗17例,非手术治疗5例.结果 22例均获得随访,随访时间25～89个月,平均41.5个月.2例(11.8％,2/17)出现切口皮缘坏死,1例(5.9％,1/17)伤口感染,无复位丢失及骨折不愈合病例.末次随访时,美国足与踝关节协会踝与后足功能评分为53～95分,平均78.9分;优5例、良10例、可7例,优良率68.2％ (15/22).1例非手术治疗患者(20.0％,1/5)发生距骨缺血性坏死.手术治疗患者中12例(70.6％,12/17)出现创伤性关节炎,累及距下关节者5例(29.4％,5/17)、胫距和距下关节者7例(41.2％,7/17),1例(5.9％,1/17)行距下关节融合术.结论距骨合并同侧跟骨骨折的受伤机制复杂,骨折类型多样.治疗骨折时应注意恢复解剖对位.创伤性关节炎是此类损伤最为常见的并发症.
목적 탐토거골합병동측근골골절적림상특정급치료효과.방법 2003년4월지2011년7월수치거골합병동측근골골절환자22례,남20례,녀2례;년령17～51세,평균30.2세;우측12례,좌측10례.치상원인:고처추락상13례,교통사고상5례,중물잡상4례.거골경골절8례:Hawkins분형Ⅰ형3례、Ⅱ형3례、Ⅲ형2례;거골체골절14례:Sneppen분형Ⅱ형6례、Ⅲ형2례、V형6례.근골관절외골절13례:근골전돌골절5례、근골결절골절2례、재거돌골절3례、근골체골절3례;관절내골절9례:Essex-Lopresti분형탑함골절7례、설형골절2례.개방성골절4례,Gustilo화Anderson분형Ⅰ형1례、Ⅱ형2례、ⅢA형1례.개방성골절우상후평균5.5 h수술,폐합성골절우상후평균제11천수술.채용내고정수술치료17례,비수술치료5례.결과 22례균획득수방,수방시간25～89개월,평균41.5개월.2례(11.8％,2/17)출현절구피연배사,1례(5.9％,1/17)상구감염,무복위주실급골절불유합병례.말차수방시,미국족여과관절협회과여후족공능평분위53～95분,평균78.9분;우5례、량10례、가7례,우량솔68.2％ (15/22).1례비수술치료환자(20.0％,1/5)발생거골결혈성배사.수술치료환자중12례(70.6％,12/17)출현창상성관절염,루급거하관절자5례(29.4％,5/17)、경거화거하관절자7례(41.2％,7/17),1례(5.9％,1/17)행거하관절융합술.결론 거골합병동측근골골절적수상궤제복잡,골절류형다양.치료골절시응주의회복해부대위.창상성관절염시차류손상최위상견적병발증.
Objective To investigate the clinical characteristics and outcomes of ipsilateral talar and calcaneal fractures.Methods From April 2003 to July 2011,22 patients with ipsilateral talar and calcaneal fractures were treated in our hospital.There were 20 males and 2 females with an average age of 30.2 years (range,17 to 51 years).The fractures occurred on the left side in 10 patients and on the right side in 12 patients.There were 8 cases of talar neck fracture,including 3 type Ⅰ,3 type Ⅱ and 2 type Ⅲ according to the Hawkins classification; there were 14 cases of talar body fracture,including 6 type Ⅱ,2 type Ⅲ and 6 type V according to the Sneppen classification.There were 13 cases of extra-articular calcaneal fracture and 9 cases of intra-articular fracture.Four patients had open fractures,including 1 type Ⅰ,2 type Ⅱ and 1 type llⅢA according to the GustiloAnderson classification.The average time from injury to surgery was 5.5 hours for patients with open fracture and 11 days for patients with close fracture.Seventeen patients underwent internal fixation and 5 patients underwent non-operative treatment.Results All patients were followed up for 25 to 89 months (average,41.5 months).Skin necrosis of the edges of the incision was found in 2 cases and wound infection in 1 case.No fracture nonunion and loss of reduction were observed in all patients.At final follow-up,the functional results were assessed according to the AOFAS score,and the average AOFAS score was 78.9 (range,53 to 95).The result was excellent in 5 patients,good in 10 and fair in 7,and the overall excellent or good rate was 68.2％.Traumatic arthritis was found in 12 patients who had undergone surgical treatment,including 5 cases in subtalar joint and 7 cases in ankle and subtalar joint.Diaz disease occurred in 1 patient who had undergone non-operative treatment.Conclusion Ipsilateral talar and calcaneal fracture is a complicated injury which has many fracture types.The fractures should be reduced anatomically,and traumatic arthritis is the most common complication.