CAJ | 학술논문

目的探讨个体化重建钢板在经跗骨窦切口治疗跟骨骨折的疗效. 方法对2010年5月至2012年9月涉及距跟关节的跟骨骨折的46例(51足)患者资料行回顾性研究,男35例,女11例;年龄17～65岁,平均35岁;左足24例,右足17例,双足5例;骨折按照Sanders分型:Ⅱ型30足,Ⅲ型21足;行经跗骨窦切口复位内固定治疗,术中根据骨折情况个体化剪裁塑形重建钢板并行内固定,必要时结合空心钉固定.比较手术前、后的B(o)hler角和Gissane角,并用美国足踝外科协会的踝-后足评分评定疗效. 结果所有患者术后获8 ～14个月(12个月)随访,所有患者均未出现切口感染、皮肤坏死、钢板松动、外露等并发症.术后3d和6个月的B(o)hler角、Gissane角[(31.70°±5.50°、122.10°±6.79°)和(30.95°±3.47°和122.49°±4.83°)]与术前(6.14°±1.58°、91.63°±4.76°)比较差异均有统计学意义(P＜0.05),而术后3d的B(o)hler角和Gissane角与术后6个月比较差异均无统计学意义(P＞0.05).所有骨折于术后6个月时均达到骨性愈合,根据美国足踝外科协会的踝-后足评分评定:优38足,良9足,可4足,优良率为92.2％. 结论应用个体化重建钢板经跗骨窦切口治疗跟骨关节内骨折,能够较好地复位骨折并行坚强内固定,减少切口并发症,有利于早期锻炼,值得推广.
목적 탐토개체화중건강판재경부골두절구치료근골골절적료효. 방법 대2010년5월지2012년9월섭급거근관절적근골골절적46례(51족)환자자료행회고성연구,남35례,녀11례;년령17～65세,평균35세;좌족24례,우족17례,쌍족5례;골절안조Sanders분형:Ⅱ형30족,Ⅲ형21족;행경부골두절구복위내고정치료,술중근거골절정황개체화전재소형중건강판병행내고정,필요시결합공심정고정.비교수술전、후적B(o)hler각화Gissane각,병용미국족과외과협회적과-후족평분평정료효. 결과 소유환자술후획8 ～14개월(12개월)수방,소유환자균미출현절구감염、피부배사、강판송동、외로등병발증.술후3d화6개월적B(o)hler각、Gissane각[(31.70°±5.50°、122.10°±6.79°)화(30.95°±3.47°화122.49°±4.83°)]여술전(6.14°±1.58°、91.63°±4.76°)비교차이균유통계학의의(P＜0.05),이술후3d적B(o)hler각화Gissane각여술후6개월비교차이균무통계학의의(P＞0.05).소유골절우술후6개월시균체도골성유합,근거미국족과외과협회적과-후족평분평정:우38족,량9족,가4족,우량솔위92.2％. 결론 응용개체화중건강판경부골두절구치료근골관절내골절,능구교호지복위골절병행견강내고정,감소절구병발증,유리우조기단련,치득추엄.
Objective To investigate the clinical efficacy of individualized reconstruction plate in the treatment of calcaneal fractures through the tarsal sinus incision.Methods From May 2010 to September 2012,we treated 46 cases of calcaneal fracture (51 feet) involving talocalcaneal joint.They were 35 males and 11 females,17 to 65 years of age (average,35 years).The injury affected the left foot in 24 cases,the right foot in 17,and both feet in 5.By the Sander's classification,30 feet were type Ⅱ and 21 type 11Ⅲ.The fractures were reduced through the tarsal sinus incision before internal fixation with individualized reconstruction according to the morphology of fracture.When necessary,fixation with hollow screws was added.The B(o)hler and Gissane angles were compared between preoperation and postoperation.The clinical efficacy was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) system.Results The patients were followed up for 8 to 14 months (average,12 months).No such complications as incision infection,skin necrosis,plate loosening or exposure occurred in this group.There were significant differences in the B(o)hler and Gissane angles between preoperation and postoperation [(31.70° ± 5.50° and 122.10° ± 6.79° at 3 days postoperation) and (30.95° ± 3.47° and 122.49° ± 4.83° at 6 months postoperation) versus (6.14° ± 1.58° and 91.63° ± 4.76° at preoperation)] (P ＜ 0.05),but no significant difference in the B(o)hler and Gissane angles between 3 days postoperation and 6 months postoperation (P ＞ 0.05).All the patients obtained bony union at 6 months postoperation.According to the AOFAS scores,38 feet were excellent,9 feet good and 4 feet fair,giving an excellent to good rate of 92.2％.Conclusion In the treatment of intra-articular calcaneal fractures through the tarsal sinus incision,application of individualized reconstruction plate can lead to fine fracture reduction,rigid internal fixation,early exercise,and decreased incision-related complications.