跟骨钢板治疗跟骨关节内骨折的疗效与解剖角度的关系  

Relationship between the efficacy of using plate for intra-articular calcaneai fractures and calcaneai anatomical angles

作　　者：李文壮[1] 蔡湘波[1] 罗胜明[1] 王国亮[1] 白卫东[1] 陈峰[1] 

机构地区：[1]广州开发区医院骨科,510730

出　　处：《中华生物医学工程杂志》2008年第3期228-231,共4页Chinese Journal of Biomedical Engineering

摘　　要：目的观察用跟骨钢板治疗跟骨关节内骨折的疗效，并探讨手术前后Bohler角（B角）、Gissane角（G角）与疗效的关系。方法收集2001年1月至2007年8月在本院接受跟骨钢板切开复位内固定治疗跟骨关节内骨折并获得随访的患者55例65足，其中SandersⅡ型16足、Ⅲ型22足、Ⅳ型27足。随访时间15—68个月，平均（33．9±13．9）个月。对患者疗效进行Kerr评分，分析术前、术后跟骨的B角、G角及其术前后的差值与术后功能评分的关系。结果术后Kerr功能评分平均得分（83．5±12．4）分，优良率86．2％；其中SandersⅡ型平均得分（91．5±9．5）分，优良率100％；Ⅲ型（82．5±14．4）分，优良率81．8％；Ⅳ型（79．5±10．1）分，优良率81．5％。多元线性回归分析结果显示，患者术前、术后B角及B角手术前后的差值均是术后功能评分的正性决定因素（P均〈0．05），术前、术后G角及G角手术前后的差值不是术后功能评分的决定因素（P均〉0．05）。结论用跟骨钢板治疗跟骨关节内骨折是一种可早期恢复功能的良好方法。B角可以作为判断治疗跟骨骨折临床疗效的指标，G角肘临床疗效没有影响。Objective To observe the efficacy of using plate for intra-articular calcaneal fractures, and to explore the relationship of the efficacy with Bohler＇s angle and Gissane＇s angle before and after operation. Methods From January, 2001 to August 2007, 55 cases 65 feet with calcaneal fractures,including Sanders type Ⅱ 16 feet, type Ⅲ 22 feet and type Ⅳ 27 feet, which received open reduction and internal fixation with calcaneal plates were followed-up for （33.9± 13.9） months （ range 15 to 68 months）. The efficacy was validated according to the score criterion designed by Kerr. At the same time, the Bohler＇s angle and Gissane＇s angle were measured before and after operations. Then, multivariate regression analysis was applied to evaluate the relationship between recovery scores and angles degrees. Results The overall average recovery score was 83.5 ± 12.4 after operation, and the excellent and good rate was 86.2%. In addition, the average recovery scores of Sanders type Ⅱ , typeⅢ and type Ⅳ were 91.5 ±9.5,82.5 ± 14.4 and 79.5 ±10.1 respectively,and the excellent and good rates were 100%,81.8% and 81. 5% respectively. Multiple linear regression analysis showed that the Bohler＇s angle before operation, Bohler＇s angle after operation and the difference of postoperative and preoperative Bohler＇s angle were positive determinants of the postoperative recovery score （all P 〈 0.05 ） ;the Gissane＇s angle before operation, Gissane＇s angle after operation and the difference of postoperative and preoperative Gissane＇s angle were not the determinants of the postoperative recovery score （ all P 〉0. 05 ）. Condusions Internal fixation with calcaneal plate for intra-articular calcaneal fracture is a good method for restoration of function early after operation. Bohler＇s angle can be used as an indicator of clinical efficacy. Gissane＇s angle is not an effective clinical indicator.

关 键 词：跟骨 骨折固定术 内 Bohler角 Gissane角 

分 类 号：R687.3[医药卫生—骨科学]