CAJ | 학술논문

目的分析距骨颈骨折手术中植骨与否对其缺血坏死发生率及功能预后的影响.方法回顾性分析我院2006年6月至2012年5月收治的49例距骨颈骨折手术患者距骨骨折坏死率及功能预后情况,其中术中行自体骨移植(A组)25例,Hawkins-Canale分型分别为Ⅱ型8例、Ⅲ型12例、Ⅳ型5例;术中未行植骨术(B组)24例,Hawkins-Canale分型分别为Ⅱ型7例、Ⅲ型13例、Ⅳ型4例;术前经AOFAS评价两组损伤程度无统计学差异,术后按Hawkins标准评价距骨坏死率及功能预后.结果49例患者随访12~32个月,平均18.7个月,19例出现距骨缺血性坏死(A组6例、B组13例),距骨缺血坏死率分别为A组24.0%,B组54.2%,其中7例需处理,3例行踝关节融合,2例行距下关节融合,2例行减压植骨;另外12例踝关节、距下关节功能良好,无距骨塌陷及骨性关节炎表现.根据Hawkins足部评分标准,优14例(A组9例)、16例(A组11例)、可12例(A组2例)、差7例(A组2例);优良率分别为A组80.0%、B组41.7%.结论距骨颈骨折(Hawkins-Canale分型为Ⅱ~Ⅳ型)术中使用自体骨移植内固定明显优于单纯复位内固定,术后距骨颈骨折缺血坏死率明显降低,且患肢功能明显优于未植骨者.
목적분석거골경골절수술중식골여부대기결혈배사발생솔급공능예후적영향.방법회고성분석아원2006년6월지2012년5월수치적49례거골경골절수술환자거골골절배사솔급공능예후정황,기중술중행자체골이식(A조)25례,Hawkins-Canale분형분별위Ⅱ형8례、Ⅲ형12례、Ⅳ형5례;술중미행식골술(B조)24례,Hawkins-Canale분형분별위Ⅱ형7례、Ⅲ형13례、Ⅳ형4례;술전경AOFAS평개량조손상정도무통계학차이,술후안Hawkins표준평개거골배사솔급공능예후.결과49례환자수방12~32개월,평균18.7개월,19례출현거골결혈성배사(A조6례、B조13례),거골결혈배사솔분별위A조24.0%,B조54.2%,기중7례수처리,3례행과관절융합,2례행거하관절융합,2례행감압식골;령외12례과관절、거하관절공능량호,무거골탑함급골성관절염표현.근거Hawkins족부평분표준,우14례(A조9례)、16례(A조11례)、가12례(A조2례)、차7례(A조2례);우량솔분별위A조80.0%、B조41.7%.결론거골경골절(Hawkins-Canale분형위Ⅱ~Ⅳ형)술중사용자체골이식내고정명현우우단순복위내고정,술후거골경골절결혈배사솔명현강저,차환지공능명현우우미식골자.
Objective To analyze the effect of chemia necrosis rate and functional outcomes after the bone graft or not intraoperative to treat talus neck fracture. Methods A retrospective analysis from June 2006 to May 2012, 49 cases were from bone neck fracture surgery patients from bone fracture necrosis rate Hawkins-Canale points respectively typeⅡfor 8 cases, typeⅢfor 12 cases, 5cases of typeⅣ;intraoperative do not use bone graft (group B), 24 cases were Hawkeins-Canale points respectively typeⅡfor 7 cases, typeⅢfor 13 cases, typeⅣfor 4 cases. Results 49 patients were followed up for 10-32 months,an average of 18.7 months, 19 cases appear avascular necrosis of talus (group A 6patients;group B, 13 patients), is apart from the bone ischemia necrosis rate of 24.0%respectively in group A, and 54.2%in group B with the need to handle 7 cases, 3 routine ankle fusion, 2 isroutine joint fusion, 2 routine decompressionand bone;The other 12 cases from the ankle, under joint function is good, no bonecollapse from osteoarthritis and performance. According to Hawkins foot evaluation criterion, optimal 14 cases (group A 9 cases), 16 cases (A group of 11 cases), can be in 12 cases(group A 2 cases), and sent in 7 patients (group A 2 cases);group A 80.0%rate respectively, B group of 41.7%. Conclusion From the bone ne-ck fractures (Hawkins-Canale points for type Ⅱ~Ⅳ), the intraoperative using autogeneous bone graft fixation is better than.the pure obvious internal fixation and bone neck fractures from post-operative ischemia necrosis rate reduced significantly, and limb function were not obviously better than the bone.