后距下关节面复位质量与跟骨骨折疗效的相关性研究  

Analysis of correlation between reduction quality of posterior subtalar articular surface and curative effect of calcaneal fracture

作　　者：唐三元[1,2] 朱学敏[1,2] 杨辉[1,2] 唐天华[1,2] 朱亚平[1,2] 

机构地区：[1]暨南大学附属珠海医院 [2]珠海市人民医院创伤骨科,广东珠海519000

出　　处：《中国矫形外科杂志》2015年第16期1448-1453,共6页Orthopedic Journal of China

基　　金：珠海市科技局计划项目(编号:201013)

摘　　要：[目的]探讨基于MSCT扫描跟骨骨折后后距下关节面复位质量与踝-后足功能恢复的相关性。[方法]2012年2月~2014年2月,按要求收集珠海市人民医院30例跟骨骨折治疗后随访9个月以上患者基本信息和影像资料,在跟骨侧位X线片上测量Bohler角、Gissane角,在MSCT冠状切面上测量后距下关节面最大水平分离、垂直塌陷移位距离并定位骨折线分布区域,将所得数据与患者AOFAS踝-后足功能评分结果进行相关性分析。[结果]后距下关节面水平分离与垂直塌陷移位距离与AOFAS评分呈负相关,垂直塌陷的影响作用比水平分离大（r=-0.517,-0.461）;水平分离和垂直塌陷移位距离≤2 mm组的优良率均明显高于〉2 mm组,差异有统计学意义（P=0.031,0.017）。后距下关节面骨折线分布区域与AOFAS评分无相关性,内外侧区优良率（69.27%,66.67%）比较差别无统计学意义（P=0.082）。[结论]跟骨后距下关节面水平分离和垂直塌陷移位距离明显影响踝-后足功能,而垂直塌陷比水平分离的影响作用更大;跟骨关节内骨折应使后距下关节面复位至2 mm内。[ Objective ] Based on the MSCT scanning, we analyzed the correlation between curative effect of ealcaneal frac- ture and the reduction quality of posterior subtalar articular surface. E Method ] From February 2012 to February 2014, according to the requirements we collected 30 patients（ 37 feet） with caleaneal fracture treated in the Zhuhai People＇s Hospital and fol- lowed up over 9 months ,the essential information and image data was recorded. We measured Bohler and Gissane angle in calca- neal lateral radiograph and measured the maximum displacement in horizontal ,vertical direction and determined the fracture line region in the MSCT coronal section of caleaneus. Analysis of the correlation between the data and patients＂ AOFAS score was made. [ Result] Displacement of posterior subtalar articular surface in horizontal and vertical direction was related negatively with patient＇s AOFAS score. Effect of vertical displacement was stronger than the horizontal displacement, standardized regression coefficient was -0.517 and -0. 461. Both vertical and horizontal, the excellent and good rate in the displacement under 2 mm is significantly higher than over 2 mm（ P = 0. 031,0. 017 ）. There was no correlation between fracture line region and AOFAS score. The difference of excellent and good results rate between medial and lateral region （69.27% ,66.67% ） had no statistical significance（ P = 0.082 ）. [ Conclusion ] Both horizontal and vertical displacement in posterior subtalar articular surface can im- pact patient＇s AOFAS score obviously, effect of vertical displacement is stronger than horizontal displacement. We should try to reduce the posterior subtalar articular surface under 2mm in the intra - articular calcaneus fracture.

关 键 词：跟骨骨折 后距下关节面 复位质量 疗效 

分 类 号：R687.3[医药卫生—骨科学]