CAJ | 학술논문

目的探讨采用改良跟骨钢板经跗骨窦入路治疗SandersⅡ、Ⅲ型跟骨骨折的疗效.方法 2012年6月至2013年12月采用改良跟骨钢板经跗骨窦入路治疗20例24足跟骨关节内骨折,男16例19足,女4例5足;年龄18 ～58岁,平均36.5岁.骨折根据Sanders分型:Ⅱ型15足,Ⅲ型9足;根据Esses-Lopresti分型:舌型骨折10足,中央塌陷型骨折14足.术后观察切口并发症发生情况以及术后及末次随访时跟骨的长度、宽度、高度、B(o)hler角及Gissane角的改善情况,并应用美国骨科足踝外科协会(AOFAS)踝-后足评分评定疗效.结果 20例24足术后获6～18个月(平均12.3个月)随访.术后未出现明显伤口并发症.X线检查示跟骨长度、宽度、高度、B(o)hler角及Gissane角基本恢复正常,随访过程中无复位丢失.按AOFAS踝-后足评分评价术后功能:SandersⅡ型15足,优10足,良4足,中1足;SandersⅢ型9足,优4足,良3足,中2足.舌型骨折10足,优7足,良3足;中央塌陷型骨折14足,优7足,良4足,中3足.结论改良跟骨钢板经跗骨窦入路治疗SandersⅡ、Ⅲ型跟骨骨折,具有显露及复位满意、伤口并发症少和固定可靠等优点,长期疗效仍有待随访.
목적 탐토채용개량근골강판경부골두입로치료SandersⅡ、Ⅲ형근골골절적료효.방법 2012년6월지2013년12월채용개량근골강판경부골두입로치료20례24족근골관절내골절,남16례19족,녀4례5족;년령18 ～58세,평균36.5세.골절근거Sanders분형:Ⅱ형15족,Ⅲ형9족;근거Esses-Lopresti분형:설형골절10족,중앙탑함형골절14족.술후관찰절구병발증발생정황이급술후급말차수방시근골적장도、관도、고도、B(o)hler각급Gissane각적개선정황,병응용미국골과족과외과협회(AOFAS)과-후족평분평정료효.결과 20례24족술후획6～18개월(평균12.3개월)수방.술후미출현명현상구병발증.X선검사시근골장도、관도、고도、B(o)hler각급Gissane각기본회복정상,수방과정중무복위주실.안AOFAS과-후족평분평개술후공능:SandersⅡ형15족,우10족,량4족,중1족;SandersⅢ형9족,우4족,량3족,중2족.설형골절10족,우7족,량3족;중앙탑함형골절14족,우7족,량4족,중3족.결론 개량근골강판경부골두입로치료SandersⅡ、Ⅲ형근골골절,구유현로급복위만의、상구병발증소화고정가고등우점,장기료효잉유대수방.
Objective To discuss the reduction and internal fixation for calcaneal fractures of Sanders types Ⅱ and Ⅲ with modified calcaneal plate through the sinus tarsi approach.Methods Open reduction and internal fixation via the sinus tarsi approach with modified calcaneal plate was performed from June 2012 to December 2013 in 20 patients with intra-articular calcaneal fracture (24 sides).They were 16 men (19 feet) and 4 women (5 feet),18 to 58 years of age (average,36.5 years).According to the Sanders classification,15 feet were of type Ⅱ and 9 feet of type Ⅲ; according to Essex-Lopresti classification,10 feet were of the tongue type and 14 feet of the joint depression type.Postoperatively,wound complications were observed and X-ray films were evaluated carefully to assess the calcaneal length,width,height,B(o)hler's and Gissane' s angles.Functional recovery was evaluated according to the ankle and hind foot score of American Orthopedic Foot and Ankle Society (AOFAS).Results Altogether 20 patients (24 feet) were followed up for an average of 12.3 months (from 6 to 18 months).There were no severe wound complications.X-ray showed basic restoration in the length,width,height,B(o)hler's and Gissane's angles of the calcaneus and noloss of reduction during the follow-up period.The AOFAS scoring showed:10 excellent,4 good and one fair cases in the 15 feet of Sanders type Ⅱ fracture; 4 excellent,3 good and 2 fair cases in the 9 feet with Sanders type Ⅲ fracture; 7 excellent and 3 good cases in the 10 feet of the tongue type; 7 excellent,4 good and 3 fair cases in the 14 feet of the joint depression type.Conclusions Surgical treatment of calcaneal fractures of Sanders' types Ⅱ and Ⅲ with modified calcaneal plate via the sinus tarsi approach can result in advantages of good exposure and reduction,limited wound complications and reliable fixation.However,long-term outcomes need to be further observed.