改良外侧L形切口解剖锁定钛板内固定治疗跟骨关节内骨折的疗效分析  

Efficacy analysis of modified external L-shaped approach with locking anatomical titanium plate internal fixation for treatment of intraarticular calcaneal fractures

作　　者：阿布杜艾尼.阿布力米提 赵岩[1] Abuduaini Abulimmiti;ZHAO Yan(Department of Microsurgical Repair, Orthopedic Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, Chin)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,新疆乌鲁木齐830054

出　　处：《中国骨与关节损伤杂志》2018年第6期594-597,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨改良外侧L形切口解剖锁定钛板内固定治疗跟骨关节内移位骨折的临床疗效。方法回顾性分析自2014-08—2016-08采用改良外侧L形切口切开复位解剖锁定钛板内固治疗的31例(35足)跟骨关节内移位骨折。比较手术前后跟骨高度、跟骨宽度、Gissane角、Bohler角,末次随访时采用AOFAS评分、Maryland评分评定疗效。结果 31例均获得随访,随访时间平均16.4(12~24)个月。骨折愈合时间2.2~3.2个月,平均2.9个月。末次随访时Bohler角、Gissane角、跟骨高度及跟骨宽度较术前明显改善,差异有统计学意义(P<0.05)。末次随访时,AOFAS评分为69~97(86.21±7.38)分,其中优14足,良18足,可3足,优良率91.4%。Maryland评分为60~94(85.26±7.73)分,其中优15足,良18足,可2足,优良率94.3%。结论改良外侧L形切口切开复位解剖锁定钛板内固定治疗跟骨关节内移位骨折可降低切口并发症发生率,固定强度可靠,术后患者Bohler角、Gissane角、跟骨高度及跟骨宽度恢复良好,功能恢复满意。经验丰富的外科医师在严格选择手术适应证的前提下施以早期手术可获得良好的疗效。Objective To investigate the clinical efficacy of modified external L-shaped incision with locking anatomical titanium plate fixation for treatment of intraarticular calcaneal fractures. Methods The clinical data of 31 patients （35 feet） with displaced intraarticular calcaneal fractures treated with open reduction and internal fixation through a modified lateral L- shaped approach from Aug. 2014 to Aug. 2016 were retrospectively analyzed. The calcaneus height, calcaneal width, Gissane angle and Bohler angle were compared before and after operation. The AOFAS score and Maryland score were used to evaluate the efficacy at the last follow-up. Results All 31 patients were followed up for an average of 16.4 （12 to 24） months. The fracture healing time was 2.2 to 3.2 months with an average of 2.9 months. At the end of follow-up, the Bohler angle, Gissane angle, calcaneal height and calcaneal width were significantly improved after operation, the difference was statistically significant （P 〈0.05）. At the last follow-up, the AOFAS score was 69-97 （86.21±7.38）, of which 14 were excellent, 18 were good, 3 were fair, and the excellent and good rate was 91.4%. The Maryland score was 60-94 （85.26±7.73）, of which 15 were excellent., 18. were good, 2 were fair, and the excellent and good rate was 94.3%. Conclusion Modified external L- shaped approach with locking anatomical titanium plate internal fixation for treatment of intraarticular calcaneal fractures can reduce the incidence of incision complications. The fixation strength is reliable, and the postoperative Bonhler angle, Gissane angle, calcaneal height, and calcaneal width recovered well and their functional recovery is satisfactory. The good clinical results can be obtained with early surgery on the premise of strict selection of surgical indications under experienced surgeon.

关 键 词：跟骨关节内移位骨折 改良外侧L形切口 解剖锁定钛板 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]