CAJ | 학술논문

目的探讨采用克氏针撬拨复位,微创小切口钢板全螺纹松质骨钉内固定治疗跟骨关节内骨折的临床疗效.方法2009年9月开始采用微创钢板螺栓加压内固定系统治疗跟骨关节内骨折,在实践中不断探索改进,于2011年2月开始将部分病例采用全螺纹松质骨螺钉替代加压螺栓固定,取得良好临床效果.此组病人40例;男21例,女19例;年龄21~65岁,平均41岁;左足16例,右足24例;均为闭合性跟骨关节内移位骨折,致伤原因:高处坠落伤29例,车祸伤11例;合并脊柱骨折2例,骨盆骨折1例,同侧股骨骨折2例.骨折按Sanders分型:Ⅱ型12例,Ⅲ型24例,Ⅳ型4例.所有患者术前行 X 线检查和 CT 扫描三维重建,以了解跟骨压缩的程度和关节面的完整性.结果所有患者术后均获得3~16月(平均12月)随访.切口均甲级愈合.Bohler 角、Gissane 角和跟骨宽度分别由术前的6.05°±3.56°、159.27°±10.62°、41.17±2.06mm 恢复到术后的31.86°±2.67°、117.24°±8.47°、31.25±1.78mm,3个月后为32.61°±4.56°、119.59°±2.11°、32.12±1.86mm.骨折完全愈合,无一例发生切口皮缘坏死和感染、腓骨长短肌肌腱腱鞘炎,未出现骨折移位或内固定失败等情况.美国骨科足踝外科学会(American Orthopaedic Foot &Ankle Society,AOFAS)评分系统的踝-后足评分为术前20.73±11.92分、术后3天71.38±9.47分、术后3个月72.76±17.62分.结论全螺纹松质骨螺钉替代自断型加压螺栓进行固定,可有效恢复跟骨的宽度,避免了内侧神经血管的损伤,易于取出,并发症少,临床效果满意.
목적탐토채용극씨침효발복위,미창소절구강판전라문송질골정내고정치료근골관절내골절적림상료효.방법2009년9월개시채용미창강판라전가압내고정계통치료근골관절내골절,재실천중불단탐색개진,우2011년2월개시장부분병례채용전라문송질골라정체대가압라전고정,취득량호림상효과.차조병인40례;남21례,녀19례;년령21~65세,평균41세;좌족16례,우족24례;균위폐합성근골관절내이위골절,치상원인:고처추락상29례,차화상11례;합병척주골절2례,골분골절1례,동측고골골절2례.골절안Sanders분형:Ⅱ형12례,Ⅲ형24례,Ⅳ형4례.소유환자술전행 X 선검사화 CT 소묘삼유중건,이료해근골압축적정도화관절면적완정성.결과소유환자술후균획득3~16월(평균12월)수방.절구균갑급유합.Bohler 각、Gissane 각화근골관도분별유술전적6.05°±3.56°、159.27°±10.62°、41.17±2.06mm 회복도술후적31.86°±2.67°、117.24°±8.47°、31.25±1.78mm,3개월후위32.61°±4.56°、119.59°±2.11°、32.12±1.86mm.골절완전유합,무일례발생절구피연배사화감염、비골장단기기건건초염,미출현골절이위혹내고정실패등정황.미국골과족과외과학회(American Orthopaedic Foot &Ankle Society,AOFAS)평분계통적과-후족평분위술전20.73±11.92분、술후3천71.38±9.47분、술후3개월72.76±17.62분.결론전라문송질골라정체대자단형가압라전진행고정,가유효회복근골적관도,피면료내측신경혈관적손상,역우취출,병발증소,림상효과만의.
@@@@Objective To explore the use of Kirschner wire poking reduction and clinical efficacy of minimally invasive small incision steel threaded cancellous bone screw fixation for the treatment of intra-articular calcaneal fracture. Method In Sep. 2009 with bolt pressure of minimally invasive plate fixation system and intra-articular calcaneal fractures continue to explore ways to improve in practice, some cases in Feb. 2011 full threaded cancellous screws instead of bolted pressure, achieved good clinical effect. 40 cases of this group of patients; 21 males and 19 females; aged 21 to 65 years (average of 41 years); left foot 16 cases, 24 cases of right foot; closed intra-articular calcaneal fractures, the causes of injury:height 29 cases of fall injury and traffic accident in 11 cases; combined spinal fractures 2 cases of pelvic fracture patients, the ipsilateral femoral fracture in two cases. Fracture the Sanders classification: type II 12 cases, 24 cases III, IV 4 cases. All patients underwent preoperative X-ray examination and CT scan three-dimensional reconstruction, in order to understand the extent and integrity of the articular surface of the calcaneus compression. Results All the patients were 3 to 16 months (mean 12 months). Incisions were healing. Bohler angle, Gissane angle, and calcaneal width from the preoperative 6.05°±3.56°, 159.27°±10.62°, 41.17±2.06mm to return to after surgery31.86°±2.67°, 117.24°±8.47°, 31.25±1.78mm, after 3 months 32.61°±4.56°, 119.59°±2.11°, 32.12±1.86mm. Fractures healed completely, and no case of skin flap necrosis and infection, peroneal tendons, tenosynovitis, and the fracture displacement or internal fixation failure. AOFAS scoring system of the ankle-foot score 20.73±11.92, after 3 days 71.38±9.47 in the preoperative, postoperative 3 months 72.76±17.62 points. Conclusion Threaded cancellous bone screw instead of the fixed off pre-ssurized bolt, which can effectively restore the width of the calcaneus to avoid the medial neurovascular damage, easy to remove, fewer complications, satisfactory clinical results.