CAJ | 학술논문

目的：比较闭合撬拨复位＋空心螺钉内固定术与切开复位＋钛钢板内固定术治疗Sanders Ⅱ型、Ⅲ型跟骨骨折疗效，探讨治疗跟骨骨折的有效方法。方法：对我科2012年2月－2015年4月收治的46例（51足）跟骨骨折患者进行回顾性总结分析，骨折类型：依据Sanders CT分类法：属Ⅱ型、Ⅲ型，其中24例（28足）采用经皮撬拨复位＋空心螺钉内固定术（撬拨复位组），22例（23足）采用切开复位＋钢板螺钉内固定术（切开复位组），根据术前、术后X片检查测量Bohler角，采用Maryland足部功能评分系统评价术后患者足部功能，并比较两种术式术后并发症情况。结果：X线示两组患者跟骨骨折端均骨性愈合，撬拨复位组Bohler角由术前的（18．42±3．40）°恢复至术后的（30．20±2.88）°，切开复位组Bohler角由术前的（17．68±2．80）°恢复至术后的（32．46±2．08）°，术后功能评价撬拨复位组优良率72.6％，切开复位组优良率78．8％，两组间差异均无统计学意义（ P均＞0．05）。术后撬拨复位组无1例切口感染、裂开；术后切开复位组出现3例切口感染、皮缘坏死，1例钢板外露。结论：经皮撬拨复位＋空心螺钉内固定术与切开复位＋钢板螺钉内固定术治疗跟骨骨折都是比较实用可行的术式，术后疗效相近，两者有各自的优缺点，前者可以最大限度降低术后的切口皮缘坏死及感染风险，降低患者经济负担。
목적：비교폐합효발복위＋공심라정내고정술여절개복위＋태강판내고정술치료Sanders Ⅱ형、Ⅲ형근골골절료효，탐토치료근골골절적유효방법。방법：대아과2012년2월－2015년4월수치적46례（51족）근골골절환자진행회고성총결분석，골절류형：의거Sanders CT분류법：속Ⅱ형、Ⅲ형，기중24례（28족）채용경피효발복위＋공심라정내고정술（효발복위조），22례（23족）채용절개복위＋강판라정내고정술（절개복위조），근거술전、술후X편검사측량Bohler각，채용Maryland족부공능평분계통평개술후환자족부공능，병비교량충술식술후병발증정황。결과：X선시량조환자근골골절단균골성유합，효발복위조Bohler각유술전적（18．42±3．40）°회복지술후적（30．20±2.88）°，절개복위조Bohler각유술전적（17．68±2．80）°회복지술후적（32．46±2．08）°，술후공능평개효발복위조우량솔72.6％，절개복위조우량솔78．8％，량조간차이균무통계학의의（ P균＞0．05）。술후효발복위조무1례절구감염、렬개；술후절개복위조출현3례절구감염、피연배사，1례강판외로。결론：경피효발복위＋공심라정내고정술여절개복위＋강판라정내고정술치료근골골절도시비교실용가행적술식，술후료효상근，량자유각자적우결점，전자가이최대한도강저술후적절구피연배사급감염풍험，강저환자경제부담。
Objective :To compare the clinical effical between Closed Reduction and Percutaneous Screw Fixation and open reduction internal fixation with titanium plate in the treatment of Sanders Ⅱ ,Ⅲ calcaneal fractures ,to explore ef‐fective method for the treatment of .Methods :February 2012 to April 2015 ,our department of 46 cases of foot (51) in patients with calcaneal fractures were retrospectively summarized analysis ,fracture type:according to the Sanders CT classification :type Ⅱ and type Ⅲ ,24 cases (28 feet) by percutaneous prying reset+sunyata screw fixation (percutane‐ous reduction group) ,22 cases (23 feet) adopts the open reduction plus steel screw fixation (open reduction group) , according to the preoperative and postoperative X‐ray check Bohler’s angle measurement ,the Maryland foot function score system evaluation of postoperative patients with foot function ,and compare the two kinds of operative methods postoperative complications .Results:X‐ray in two groups of patients with bone fracture end all osseous healing ,percuta‐neous reduction group ,the Bohler’s Angle by preoperative (18 .42+3 .40)° to postoperative recovery (30 .20+2 .88)° , open reduction group ,Bohler’s Angle by preoperative (17 .68+2 .80)° to postoperative recovery (32 .46+2 .08)° ,the excellent and good rates of percutaneous reduction group and open reduction group were 72 .6% and 78 .8% ,the statis‐tical difference between the two groups has no statistical significance (P>0 .05) .There was no 1 case of incision infec‐tion and split in percutaneous reduction group ;there were 3 cases postoperative incision infection ,skin necrosis and 1 case of steel exposed in open reduction group .Conclusion:Percutaneous prying reset the hollow screw fixation and open reduction and plate screw fixation in the treatment of calcaneal fractures are relatively practical and feasible operation , the postoperative curative effect ,both have their own advantages and disadvantages ,the former can minimize postopera‐tive incision edge necrosis and infection risk ,reduce the patients’economic burden .