CAJ | 학술논문

目的：探讨采用跟骨外侧T形切口入路，结合跟骨锁定钢板内固定治疗Sanders Ⅳ型跟骨骨折的临床疗效。方法：2012年1月至2014年6月采用经跟骨外侧T形切口治疗Sanders Ⅳ型跟骨骨折，并收集同期采用改良外侧L形入路病例进行回顾性研究。其中外侧T形入路、改良外侧L形入路各44例；术后随访， X线复查，测量B?hler角和Gissane角并进行比较，根据美国足与踝关节协会（ AOFAS）踝与后足功能评分评价疗效。结果：随访时间8～20个月，平均（14±3．2）个月。术后关节面复位良好，跟骨B?hler角和Gissane角恢复满意，无骨折不愈合、无内固定物折断等相关并发症发生，术后T形切口组发生3例皮肤坏死、1例创伤性关节炎；L切口组发生4例皮肤坏死，3例创伤性关节炎。术后6个月根据AOFAS踝与后足功能评分标准进行功能评分，T形切口组优良率为87．8％，AOFAS评分为（88．2±9．1）分；L形切口组优良率为78．7％， AOFAS评分为（80．1±7．6）分。两组AOFAS评分比较差异有统计学意义（t＝9．3，P＜0．05）。结论：跟骨外侧T形切口能很好暴露骨折部位，使关节面复位满意，利于跟骨解剖形态的恢复，伤口并发症少，结合跟骨解剖锁定钢板牢固固定，是治疗SandersⅣ型跟骨骨折的一种较理想的方法。
목적：탐토채용근골외측T형절구입로，결합근골쇄정강판내고정치료Sanders Ⅳ형근골골절적림상료효。방법：2012년1월지2014년6월채용경근골외측T형절구치료Sanders Ⅳ형근골골절，병수집동기채용개량외측L형입로병례진행회고성연구。기중외측T형입로、개량외측L형입로각44례；술후수방， X선복사，측량B?hler각화Gissane각병진행비교，근거미국족여과관절협회（ AOFAS）과여후족공능평분평개료효。결과：수방시간8～20개월，평균（14±3．2）개월。술후관절면복위량호，근골B?hler각화Gissane각회복만의，무골절불유합、무내고정물절단등상관병발증발생，술후T형절구조발생3례피부배사、1례창상성관절염；L절구조발생4례피부배사，3례창상성관절염。술후6개월근거AOFAS과여후족공능평분표준진행공능평분，T형절구조우량솔위87．8％，AOFAS평분위（88．2±9．1）분；L형절구조우량솔위78．7％， AOFAS평분위（80．1±7．6）분。량조AOFAS평분비교차이유통계학의의（t＝9．3，P＜0．05）。결론：근골외측T형절구능흔호폭로골절부위，사관절면복위만의，리우근골해부형태적회복，상구병발증소，결합근골해부쇄정강판뢰고고정，시치료SandersⅣ형근골골절적일충교이상적방법。
Objective:To study the clinic effect of the lateral calcaneal T-shaped incision approach combined with locking plate to treat SandersⅣcalcaneal fractures.Methods:From January 2012 to June 2014 , 88 cases <br> were collected into our study and were divided into T-shaped incision group and modificated L-shaped incision group.Each group had 44 cases.X-rays were taken in the regular follow-up.The B?hler angle and Gissane angle were measured.The treatment effect was evaluated according to the ankle and hind-foot score of American Orthopaedic Foot and Ankle Socity (AOFAS).Results: The average follow-up period was (14 ±3.2) months. The recovery of the articular surface reduction and B?ler angles and Gissane angles were satisfied.All fractures healed completely.No other internal fixation complications related fracture.There were 3 cases skin necrosis in T-shaped incision group and 4 cases in L-shaped incision group.There were 1 cases subtalar arthritis in T-shaped incision group and 3 cases in L-shaped incision group.According to the ankle and hind-foot score of AOFAS, the excellent and good rate was 87.8%in T-shaped incision group and 78.7%in L-shaped incision group,there were significant differences between the two groups(t=9.3,P<0.05).Conclusion: The lateral calcaneal T-shaped incision approach can expose the fracture fully and restore the anatomy of the calcaneus and reduce the wound complications,combined with locking plates is an effective method to treat SandersⅣcalcaneal fractures.