手术治疗跟骨关节内骨折疗效的相关因素分析  

RELATIVE FACTORS OF SURGICAL TREATMEANT IN INTRA-ARTICULAR CALCANEAL FRACTURES

作　　者：赵国志[1] 彭义[1] 曲家富[1] 曹立海[1] 赵建平 鲁宁[1] 刘奕蓉 

机构地区：[1]河北省唐山市第二医院足踝外科,063000 [2]唐山市迁安中医院足踝外科 [3]华北理工大学

出　　处：《中国煤炭工业医学杂志》2017年第4期380-384,共5页Chinese Journal of Coal Industry Medicine

基　　金：河北省科技计划项目(编号:14277737D)

摘　　要：目的了解跟骨钛钢板和微创撬拨治疗跟骨骨折的疗效。探讨影响跟骨骨折疗效的因素,包括手术方式、Sander分型、Bhler角、Gissane角等。方法以唐山市第二医院2008年5月—2013年5月采取手术治疗的足跟骨关节内骨折291例341足病例,手术方式为撬拨斯氏针固定(简称撬拨组)和钢板内固定(简称钢板组)。研究内容包括手术方式、损伤程度(分型)、术前术后跟骨的Bohler角、Gissane角以及AOFAS评分和相应的评估等级。临床检查依照美国矫形足与踝关节协会(American Orthopedic Foot and Ankle Society.AOFAS)的踝与后足评分系统进行评分。所得数据使用SPSS统计软件进行分析。结果应用AOFAS评分,发现钢板组的临床治疗效果明显优于撬拨组。钢板组平均得分(86.78±8.18)分,优良率91.6%。撬拨组平均得分(75.33±8.18)分,可见钢板组的平均得分高于撬拨组(P=0.00)。Sanders分型随分型级别越高,表明受伤程度越重,AOFAS评分逐渐降低,临床效果越差(P=0.00)。跟骨术前Bhler角(B)角异常的、术后B角异常的较术前、术后B角正常的,AOFAS评分低,临床效果差。跟骨Gissane角(G),术后G角异常对AOFAS评分有影响,术后G角异常较术后G角正常,AOFAS评分低,临床效果差。结论手术方式是影响临床治疗效果的主要因素,钢板组优于撬拨组。Sander分型级别高治疗效果差。术后B角异常治疗效果差。Objective To discuss the effect for the treatment of calcaneal fractures with calcaneus titanium plate and percutaneous minimally invasive fixation; and to investigate the factors affecting the curative effect of managing the intra - articular calcaneal fractures, including the operation method, Standers classi- fication, B（o） hler＇s angle, Gissane＇s angle. Methods From May. 2008 to May. 2013, cases of Calcaneal fractures were reviewed in author＇s hospital, and they were all intra- articular calcaneal fractures. The operation methods of caleaneal fractures were with caleaneus titanium plate（CTP group） and Percutaneous Minimally Invasive Fixation（PMI group）. This research content including operation method, classification, preoperative B（o） hler angle, Gissane angle, postoperaiton B （o） hler angle, Gissane angle, and AOFAS score. The data was analyzed using SPSS statistical, software. Results According to AOFAS score, the clinical treatment effect of CTP was obviously superior to PMI. The average score of CTP was 86.78 ± 8. 18 with superior rate of 91.6%, 75.33 ±8.18 in PMI, and it was higher than the PMI （P = 0.00）. Sand- ers classification was higher with the classification level, showed that the heavier injury degree, AOFAS score was more gradually reduced, the worse they clinical effect （P = 0.00）. The patient with the abnormal preoperative B（o）hler Angle （B angle） and postoperative B Angle, had low AOFAS scores, and clinical effect was poor. Conclusions Operation process is the main factors influencing the clinical therapeutic effect, CTP is better than PMI. Sander classification level is higher, and the treatment effect is poorer. Abnormal B Angle after operative treatment, the patients have poor effect.

关 键 词：跟骨 跟骨骨折 骨折固定术 撬拨、钢板 影响因素 

分 类 号：R683.42[医药卫生—骨科学]