CAJ | 학술논문

目的探讨跗骨窦入路治疗SandersⅢ型跟骨关节内骨折的疗效.方法回顾性分析2006年10月至2012年4月采用骨窦入路切开复位内固定治疗的90例SandersⅢ型跟骨骨折患者资料,其中男69例,女21例;年龄17 ～61岁,平均39岁;右侧49例,左侧41例.骨折根据Sanders分型:ⅢAB型26例,ⅢAC型36例,ⅢBC型28例,关节面移位均大于1 mm.采用美国骨科足踝外科协会(AOFAS)踝-后足评分对手术前、后足部功能进行评估.结果本组每例患者使用直径为4.0 mm的空心钉4～6枚,6.5 mm的全螺纹钉2枚.术后无一例患者发生切口感染、皮肤坏死及胫后神经、血管损伤等并发症.术后76例患者获10～56个月(平均20.5个月)随访.患者术后8～12周(平均9.5周)均获骨折临床愈合.末次随访时跟骨侧位、轴位X线片示跟骨骨折块复位及固定良好,跟骨长度、宽度、高度、B(o)hler角及Gissane角较术前改善,差异均有统计学意义(P＜0.05).AOFAS踝-后足评分为70～100分,其中优45例,良24例,可5例,差2例,优良率为90.8％.无一例患者发生伤口感染、骨不连、骨髓炎等严重并发症.结论采用跗骨窦入路切开复位内固定治疗移位超过1 mm的SandersⅢ型跟骨关节内骨折术后疗效满意.
목적 탐토부골두입로치료SandersⅢ형근골관절내골절적료효.방법 회고성분석2006년10월지2012년4월채용골두입로절개복위내고정치료적90례SandersⅢ형근골골절환자자료,기중남69례,녀21례;년령17 ～61세,평균39세;우측49례,좌측41례.골절근거Sanders분형:ⅢAB형26례,ⅢAC형36례,ⅢBC형28례,관절면이위균대우1 mm.채용미국골과족과외과협회(AOFAS)과-후족평분대수술전、후족부공능진행평고.결과 본조매례환자사용직경위4.0 mm적공심정4～6매,6.5 mm적전라문정2매.술후무일례환자발생절구감염、피부배사급경후신경、혈관손상등병발증.술후76례환자획10～56개월(평균20.5개월)수방.환자술후8～12주(평균9.5주)균획골절림상유합.말차수방시근골측위、축위X선편시근골골절괴복위급고정량호,근골장도、관도、고도、B(o)hler각급Gissane각교술전개선,차이균유통계학의의(P＜0.05).AOFAS과-후족평분위70～100분,기중우45례,량24례,가5례,차2례,우량솔위90.8％.무일례환자발생상구감염、골불련、골수염등엄중병발증.결론 채용부골두입로절개복위내고정치료이위초과1 mm적SandersⅢ형근골관절내골절술후료효만의.
Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.