Orthofix外固定支架治疗跟骨关节内骨折的技巧及疗效分析  

Treatment of displaced intra-articular calcaneal fractures with Orthofix external fixation

作　　者：张涛[1] 万春友[1] 徐卫国[1] 马宝通[1] 梅晓龙[1] 贾鹏[1] 姚辉[1] 

机构地区：[1]天津市天津医院骨科,天津300211

出　　处：《中华创伤骨科杂志》2016年第12期1040-1045,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的通过与内固定比较，探讨采用Orthofix外固定支架治疗跟骨关节内骨折的方法及疗效。方法回顾性分析2013年2月至2014年12月手术治疗的39例跟骨骨折患者资料（41侧跟骨，其中2例为双侧跟骨骨折），男27例，女12例；年龄27～56岁，平均42．5岁；左足15侧，右足26侧。跟骨骨折按Sanders分型：Ⅱ型11侧，Ⅲ型22侧，Ⅳ型8侧。开放性跟骨骨折5侧，按Gustilo分型：Ⅰ型2侧，Ⅱ型3侧。局部软组织条件不佳的跟骨骨折11侧，按Tscherne．Oestern软组织损伤分类：Fr．CⅠ型4侧，Fr．CⅡ型7侧。根据手术方式不同分为外固定组（25侧）和内固定组（16侧），比较两组患者围手术期相关指标和随访时的影像学指标，采用美国足踝外科协会（AOFAS）的踝一后足功能评分评价足踝功能。结果外固定组患者的手术时间、术中出血、住院时间、骨愈合时间均小于内固定组，差异有统计学意义（P〈0．05）。两组患者随访时间、AOFAS的踝．后足评分和术后影像学资料比较差异均无统计学意义（P〉0．05）。末次随访时按AOFAS的踝一后足功能评分结果，外固定组：优15侧，良8侧，可2侧；内固定组：优10侧，良5侧，可1侧。结论应用Orthofix外固定支架能够治疗跟骨各型骨折，其具有早期手术不受局部软组织条件限制、减少手术侵袭即对跟骨血供的破坏、降低感染发生率的优势，并能够取得良好的临床效果。Objective To evaluate clinical outcomes of treating displaced intra-articular calcaneal fractures with Orthofix external fixation （EF） in comparison with open reduction and internal fixation （ORIF）. Methods Between February 2013 and December 2014, 39 patients with 41 calcaneal fractures were treated operatively and fully followed up at our department. They were 27 men and 12 women, aged from 27 to 56 years（average, 42. 5 years）. The left foot was affected in 15 cases and the right in 26. By the Sanders classification, there were 11 cases of type Ⅱ, 22 ones of type Ⅲ and 8 ones of type Ⅳ. The 5 open fractures were Gustilo type Ⅰ（2 cases） and Gustilo type Ⅱ （3 cases）. Of the 11 fractures complicated with soft tissue injury, 4 wre Tescherne-Oestern type Ⅰ and 7 Tscherne-Oestern type Ⅱ. The patients were divided into group EF （25 cases） and group ORIF （16 cases） according to the operation they had received. The 2 groups were compared in intraoperative indexes and follow-up radiological data. The American Orthopaedic Foot and Ankle Society （AOFAS） scores for ankle and hindfoot were recorded at the final follow-up for every patient. Results The mean duration of surgery, intraoperative bleeding, time for hospitalization and bone healing in group EF were significantly less than in group ORIF （ P 〈 0. 05）. There were no significant differences be- tween the 2 groups in follow-up duration, AOFAS score, Bοhler angle, Gissane angle, calcaneal axis, cal- caneal horizontal length, tuberosity height, hillock calcaneal height, calcaneal width, or talar inclination angle （ P 〉 0. 05）. According to the AOFAS scores at the final follow-ups, 15 cases were rated as excellent, 8 as good and 2 as fair in group EF while 10 were rated as excellent, 5 as good and one as fair in group ORIF. Conclusions All types of calcaneal fracture can be treated using Orthofix external fixation which may lead to advantages of earlier surgery regardless of soft tissue condition, minimal invasiven

关 键 词：跟骨 骨折 开放性 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]