单侧外固定支架结合有限内固定治疗跟骨关节内骨折  

Treatment of intra articular calcaneal fractures with unilateral external fixator combined with limited internal fixation

作　　者：柴雷子[1] 薛锋[1] 肖海军[1] 丁亮[1] 沈玉春[1] 赵勇[1] 

机构地区：[1]上海市交通大学附属第六人民医院南院,上海201499

出　　处：《中国骨伤》2013年第11期889-893,共5页China Journal of Orthopaedics and Traumatology

基　　金：上海市卫生局课题(编号:2007045)~~

摘　　要：目的:探讨单侧外固定支架结合空心钉有限内固定治疗跟骨关节内骨折的临床疗效。方法:2007年5月至2012年2月,采用单侧外固定支架结合空心钉有限内固定治疗52例(58足)跟骨关节内骨折患者,其中男45例(51足),女7例(7足);年龄18～64岁,平均36.5岁;受伤至手术时间4～13 d,平均(6.2±0.8)d。根据Sanders分型:Ⅱ型36例(40足),Ⅲ型13例(15足),Ⅳ型3例(3足)。患足术前均行跟骨轴、侧位X线片及CT扫描。测量手术前后跟骨B觟hler角、Gissane角、长度、高度和宽度。采用Maryland足部评分系统进行功能评估。结果:52例(58足)中51例(57足)获得随访,时间5～16个月,平均7.2个月。跟骨B觟hler角术前(12.65±5.32)°与术后(30.63±4.28)°比较差异有统计学意义(P<0.05);术前Gissane角(129.87±6.25)°与术后(122.11±4.89)°比较差异有统计学意义(P<0.05);跟骨长度、宽度及高度术前分别为(64.5±7.1)mm、(34.6±5.7)mm、(30.2±5.2)mm,术后分别为(71.3±5.7)mm、(28.2±6.1)mm、(39.3±6.4)mm,术后与术前比较差异有统计学意义(P<0.05)。采用Maryland评分系统评估足部功能:优20足,良31足,可4足,差2足。3足因手术发生皮缘坏死,经清创、换药后获得愈合。结论:单侧外固定支架结合有限内固定治疗跟骨关节内骨折具有损伤小、并发症少、功能恢复好等优点,近期疗效满意。Objective ：To study the clinical effects of the unilateral external fixator combined with limited internal fixation such as cannulated lag screws for the treatment of intra-articular calcaneal fractures. Methods：From May 2007 to February 2012,52 patients （58 feet） with intraarticular calcaneal fractures were treated with unilateral external fixator and limited internal fixation such as lag screws. Forty-five patients （51 feet） were male ,7 patients （7 feet） were female ,ranging in age from 18 to 64 years ,averaged 36.5 years. Time from injury to surgery was 4 to 13 （6.2±0.8） days. According to Sanders classification, there were 36 cases （40 feet） with type II fractures, 13 cases （15 feet） with type m fractures ,3 cases （3 feet） with type IV fractures. All patients were examed with X-ray and CT. Bohler angle, Gissane angle, length, width, height were measured on the radiographs, respectively. The function of the feet was assessed by the Maryland grading system. Results：Fifty-one patients （57 feet） were followed up for 5 to 16 months,with an average of 7.2 months. Calcaneal B6hler angle increased from （12.65± 5.32）°preoperatively to （30.63±4.28）° postoperatively. The calcaneal Gissane angle decreased from （129.87±6.25）° preoperatively to （122.11±4.89）° postoperatively. The calcaneal length increased from （64.5±7.1） mm preoperatively to （71.3± 5.7） mm postoperatively. The calcaneal width decreased from （34.6±5.7） mm preoperatively to （28.2±6.1） mm postoperatively. The ealcaneal height increased from （30.2±5.2） mm preoperatively to （39.3±6.4） mm postoperatively. All of the comparison between preoperative and postoperative measurements revealed statistically significant （P〈0.05）. The length,width, height, Bohler angle and Gissane angle were improved significantly （P〈0.05）. According to the Maryland grading system,the result was excellent in 20 feet, good in 31 feet, fair in 4 feet, pour in 2 feet, excellent and goo

关 键 词：跟骨 骨折 骨折固定术 内 外固定器 

分 类 号：R683.42[医药卫生—骨科学]