解剖型跟骨外固定装置治疗跟骨骨折的近期疗效分析  

Treatment of calcaneal fracture with anatomical calcaneal external fixator

作　　者：夏燊 徐永清 吕乾 朱跃良 Xia Shen;Xu Yongqing;Lyu Qian;Zhu Yueliang(Department of Orthopaedics,920 Hospital of the PLA Joint Logistics Support Force,Kunming 650032,China;Department of Orthopedic Surgery,The Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China)

机构地区：[1]解放军联勤保障部队第九二〇医院骨科,昆明650032 [2]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华创伤骨科杂志》2022年第6期496-502,共7页Chinese Journal of Orthopaedic Trauma

基　　金：云南省骨科与运动康复临床医学研究中心建设项目(202102AA310068)。

摘　　要：目的探讨解剖型跟骨外固定装置治疗跟骨骨折的近期疗效。方法回顾性分析2019年9月至2020年3月期间解放军联勤保障部队第九二〇医院骨科收治的9例跟骨骨折患者资料。男7例,女2例;年龄为23~66岁,平均41.3岁。致伤原因:高处坠落伤6例,交通伤3例。骨折按Sanders分型:ⅡB型2例,ⅢAC型2例,ⅢAB型3例,ⅢBC型1例,Ⅳ型1例。闭合性骨折8例,按AO闭合软组织损伤分级:Ⅰ级5例,Ⅱ级3例;开放性骨折1例,按Gustilo-Anderson分型为Ⅲb型,该患者清创后行皮瓣修复创面。所有患者均在一期(8例)或二期(1例)手术过程中应用解剖型跟骨外固定装置治疗。记录患者的骨折愈合时间,末次随访时根据美国足踝外科协会(AOFAS)踝-后足评分、Ilizarov方法研究与应用协会(ASAMI)协议评定疗效等。结果9例患者术后获6~18个月(平均9.8个月)随访。本组患者的骨折愈合时间为2~4个月,平均2.8个月。末次随访时AOFAS踝-后足评分男性患者为79~93分(平均84.7分),优6例,良1例;女性患者为82~91分(平均86.5分),优1例,良1例。末次随访时根据ASAMI协议评定疗效:优6例,良2例,可1例。闭合性骨折患者术后3 d即可下床行康复锻炼。随访期间无一例患者出现针道感染、骨髓炎等并发症。结论解剖型跟骨外固定装置治疗跟骨骨折的近期疗效良好,其具有解剖构型、内置物占位少、术后第3天即可下地部分负重进行康复锻炼等优点。Objective To investigate the short-term efficacy of anatomical calcaneal external fixator in the treatment of calcaneal fractures.Methods A retrospective study was conducted of the 9 patients with calcaneal fracture who had been admitted to Department of Orthopedics,920 Hospital of the PLA Joint Logistics Support Force between September 2019 and March 2020.There were 7 males and 2 females,aged from 23 to 66 years(mean,41.3 years).The injury was caused by a fall from a height in 6 cases and a traffic accident in 3 cases.By the Sanders classification,there were 2 cases of typeⅡB,2 cases of typeⅢAC,3 typeⅢAB,one of typeⅢBC and one typeⅣ.By the AO grading for closed soft tissue injury in the 8 closed fractures,there were 5 cases of gradeⅠand 3 cases of gradeⅡ.The one open fracture was typeⅢB by the Gustilo-Anderson classification and treated with skin flap repair after debridement.All the 9 patients were treated with an anatomic calcaneal external fixator during stage-one or stage-two surgery(8 patients in stage-one and one in stage-two).The fracture union time for the patients was recorded;the ankle and hindfoot score of American Orthopedic Foot and Ankle Society(AOFAS)and the protocol of Association for the Study and Application of the Method of Ilizarov(ASAMI)were used at the last follow-up to assess the short-term efficacy.Results Postoperative follow-up for the 9 patients ranged from 6 to 18 months(mean,9.8 months).The duration of fracture union in the 9 patients ranged from 2 to 4 months(mean 2.8 months).The AOFAS ankle and hindfoot score at last follow-up ranged from 79 to 93 points(mean,84.7 points)for the male patients(6 excellent and one good),and from 82 to 91 points(mean,86.5 points)for the female patients(one excellent and one good).According to the ASAMI protocol at last follow-up,the short-term efficacy was rated as excellent in 6 cases,as good in 2 cases and as fair in one.The patients with closed fracture could get out of bed for rehabilitation on day 3 after surgery.None of the patie

关 键 词：跟骨 骨折 骨折固定术 外固定器 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]