跟骨关节内骨折钢板内固定与克氏针内固定的比较  

TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES USING KIRSCHNER’S WIRE OR CALCANEAL PLATE

作　　者：李学金[1] 李群[1] 张知博[1] 温晓燕[1] 严宏践[1] 

机构地区：[1]秦皇岛市第一医院骨科,河北秦皇岛066000

出　　处：《中国修复重建外科杂志》2008年第4期459-462,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较采用克氏针内固定和钢板内固定治疗跟骨关节内骨折的效果。方法回顾性分析2003年3月-2006年3月收治的71例86足跟骨关节内骨折手术治疗的患者资料,均为闭合性骨折。其中39例48足使用克氏针内固定,男34例,女5例;年龄15～64岁,平均36岁;病程4h～10d。双侧骨折9例,单侧骨折30例;根据Sanders分型,Ⅱ型40足,Ⅲ型7足,Ⅳ型1足。32例38足使用标准AO跟骨钢板内固定,男30例,女2例;年龄18～55岁,平均33岁;病程4h～10d。双侧骨折6例,单侧骨折26例;SandersⅡ型31足,Ⅲ型5足,Ⅳ型2足。对术后随访超过12个月的患者进行评估,评估项目包括:术前和术后Bohler角、Gissane角;对单侧跟骨骨折评估跟骨高度和宽度(与健侧对比);通过手术前后的CT扫描和Borden位判断复位情况;功能评估采用美国足踝骨科协会(American Orthopedic Foot & Ankle Society,AOFAS)的评分系统。结果克氏针内固定组获随访12～48个月,AOFAS评分75～100分,平均90.6分;优良率为87.8%。Bohler角术前0～10°,平均7.8°;随访时30～40°,平均33.2°;Gissane角术前75～95°,平均84°;术后115～135°,平均125°;手术前后差异有统计学意义(P<0.05)。术后并发症:切口皮缘表浅坏死1足,针道感染1足。钢板内固定组获随访12～48个月,AOFAS评分49～100分,平均87.5分;优良率81.6%,与克氏针内固定组比较差异无统计学意义(P>0.05)。Bohler角术前0～15°,平均6.5°;随访时25～40°,平均30.2°;Gissane角术前72～92°,平均80°;术后115～130°,平均120°;手术前后差异有统计学意义(P<0.05)。术后并发症:切口皮缘坏死5足,腓肠神经损伤1足,腓骨肌腱鞘炎1足。结论跟骨关节内骨折切开复位钢板内固定与克氏针内固定可获得相似的治疗效果,但克氏针内固定操作更加简便、经济、创伤小,软组织风险更低。Objective To compare the effect and syndrome of treating intra-articular calcaneal fractures using Kirschner＇s wire or AO calcaneal plate. Methods From March 2003 to March 2006, 71 cases （86 feet） of intra-articular calcaneal fractures were treated with Kirschner＇s wire or AO calcaneal plate. Among them, 39 cases （48 feet） were treated using Kirschner＇s wire, male 34, female 5. The age ranged from 15 to 64 years old, 36 on average. The course of illness was from 4 hours to 10 days. There were 9 double side bone fractures and 30 one side bone fractures. Based on Sanders type, Type II were 40 feet, Type III were 7 feet and Type IV was 1 foot. The other 32 cases （38 feet） were treated using AO calcaneal plate, male 30, female 2. The age ranged from 18 to 55 years old, 33 on average. The course of illness was from 4 hours to 10 days. There were 6 double side bone fractcres and 26 one side bone fractures. A total of 31 feet belonged to Sanders Type Ⅱ, 5 to Type Ⅲ, and 2 to Type Ⅳ. The 12-month follow-up, at least, was carried out in order to valuate the patients. The valuating items included： preoperative and postoperative Bohler＇s angle and Gissane＇s angle; heel bone height and width（contrast with the opposite side）; to judge reposition circs by means of the CT scan and Borden＇s judgment; function valuation adopting the American Orthopedic Foot ＆ Ankle Society （AOFAS） grade point system. Results Patients with Kirschner＇s wire fixed were followed up for 12 to 48 months, and AOFAS score ranged from 75 to 100 points, 90.6 on average. The excellent and good rate was 87.8%. The preoperative Bohler＇s angle was from 0 to 10°, 7.8° on average, and postoperative from 30 to 40°, 33.2° on average. The preoperation Gissane＇s angle was 75 to 95°, 84° on average; and postoperative from 115 to 135°, 125° on average. There was significant difference （P 〈 0.05）. The postoperative complications were that 1 foot was the incision edge shallow putrescence and 1 foot was the ne

关 键 词：跟骨骨折 关节内骨折 克氏针内固定 跟骨钢板 比较 

分 类 号：R687[医药卫生—骨科学]