CAJ | 학술논문

背景:跟骨关节内骨折是一种常见但却较复杂的骨折.如果治疗不当,可能会留有严重的并发症.目的:探讨小切口联合经皮撬拨复位交叉克氏针固定治疗跟骨关节内骨折的临床疗效.方法:2012年1月至2013年8月,52例(58足,SandersⅡ~Ⅳ型)闭合性跟骨骨折患者采用跗骨窦小切口联合经皮撬拨复位交叉克氏针固定进行治疗.男44例(48足),女8例(10足);年龄19~66岁,平均39.6岁.术后测量B?hler角、Gis-sane角、跟骨长度及宽度、高度,并与术前值相比较.术后6个月根据AOFAS踝-后足评分评估足功能情况.结果:术后随访9~18个月,平均14个月.所有跟骨切口均一期甲级愈合,克氏针针孔无渗出、感染.跟骨骨折于术后8~12周临床愈合,平均10.5周.跟骨后关节面无塌陷发生,X线片示B?hler角和Gissane角跟骨外形基本恢复正常,跟骨长度、宽度、高度均恢复满意.术后6个月AOFAS踝-后足评分:优36足、良14足、一般6足、差2足.疗效差的2足均为SandersⅣ型骨折,后关节面粉碎严重,术后并发距下关节炎,后行距下关节融合术治愈.结论:小切口联合经皮撬拨复位交叉克氏针固定治疗跟骨关节内骨折操作简便、手术时间短、创伤小、费用低、术后并发症少、临床疗效满意.
배경:근골관절내골절시일충상견단각교복잡적골절.여과치료불당,가능회류유엄중적병발증.목적:탐토소절구연합경피효발복위교차극씨침고정치료근골관절내골절적림상료효.방법:2012년1월지2013년8월,52례(58족,SandersⅡ~Ⅳ형)폐합성근골골절환자채용부골두소절구연합경피효발복위교차극씨침고정진행치료.남44례(48족),녀8례(10족);년령19~66세,평균39.6세.술후측량B?hler각、Gis-sane각、근골장도급관도、고도,병여술전치상비교.술후6개월근거AOFAS과-후족평분평고족공능정황.결과:술후수방9~18개월,평균14개월.소유근골절구균일기갑급유합,극씨침침공무삼출、감염.근골골절우술후8~12주림상유합,평균10.5주.근골후관절면무탑함발생,X선편시B?hler각화Gissane각근골외형기본회복정상,근골장도、관도、고도균회복만의.술후6개월AOFAS과-후족평분:우36족、량14족、일반6족、차2족.료효차적2족균위SandersⅣ형골절,후관절면분쇄엄중,술후병발거하관절염,후행거하관절융합술치유.결론:소절구연합경피효발복위교차극씨침고정치료근골관절내골절조작간편、수술시간단、창상소、비용저、술후병발증소、림상료효만의.
Background:Intra-articular calcaneal fractures are common diseases with a high morbidity. Severe complications may oc-curred once proper treatment is not performed. Objective:To explore the clinical outcome of minimally invasive incision combined with percutaneous poking reduction by Kirschner wire fixation for calcaneal intra-articular fractures. Methods:Fifty two patients (fifty eight heels, SandersⅡ-Ⅳ) with a displaced intra-articular calcaneal fracture were surgi-cally treated through the sinus tarsi approach combined with percutaneous poking reduction by Kirschner wire fixation be-tween January 2012 and August 2013. There were 44 males (48 heels) and 8 females (10 heels) with a mean age of 39.6 years (range, 19-66 years). B?hler angle, Gissane angle and the length, width, height of calcanea were measured after sur-gery and compared with preoperative ones. The ankle function was assessed according to the AOFAS ankle-hindfoot score 6 months after surgery. Results:The mean duration of follow-up was 14 months (range, 9-18 months). All the incision were healed. No effusion, in-fection or collapse of the facies articularis posterior calcanei occurred. The mean duration of clinical healing of the fractures was 10.5 weeks (range, 8-12 weeks). X-ray showed that the B?hler angle, Gissane angle and calcaneal length, width and height were improved. According to AOFAS ankle-hindfoot score, operation results were excellent in 36 heels, good in 14 heels, fair in 6 heels, and poor in 2 heels 6 months after surgery. The posterior articular facet of the two poor heels crashed severely in which subtalar arthritis occurred after surgery and the subtalar arthrodesis were performed. Conclusions:It is safe and effective to treat calcaneal intra-articular fractures by minimally invasive incision combined with percutaneous poking reduction with Kirschner wire fixation.