自体髂骨移植在移位型跟骨关节内骨折治疗中的临床价值分析  

Clinical value of autologous iliac bone graft in the treatment of displaced intra-articular fractures of the heel bone

作　　者：王岩岩 曹广超 杨龙 李亮 石荣剑 WANG Yan-yan;CAO Guang-chao;YANG Long;LI Liang;SHI Rong-jian(Department of Foot and Ankle Surgery,Xuzhou Renci Hospital,Xuzhou,Jiangsu,221000,China)

机构地区：[1]徐州仁慈医院足踝外科,江苏省221000

出　　处：《中国骨与关节杂志》2023年第9期671-677,共7页Chinese Journal of Bone and Joint

摘　　要：目的探讨移位型跟骨关节内骨折(displaced intra-articular calcaneal fracture,DIACF)进行自体髂骨移植的临床必要性。方法选取我院在2020年10月至2021年1月收治的62例DIACF患者,按照随机数字表法分为对照组[切开复位内固定(open reduction and internal fixation,ORIF)]及观察组(ORIF联合自体髂骨移植),每组各31例。基于X线检查比较两组患者临床影像学参数(Bohler角、Gissane角及跟骨高度、宽度和长度);通过美国足踝关节外科协会(American Orthod&Ankle Society,AOFAS)评分和疼痛视觉模拟评分(visual analogue scale,VAS)评估足部功能和疼痛程度。结果观察组手术时间和住院时间高于对照组;完全负重时间短于对照组,差异均有统计学意义(P<0.05)。术后1年,观察组的Bohler角高于对照组[(26.15±3.11)°vs.(24.41±3.24)°,P<0.05],Bohler角丢失角度低于对照组[(2.39±1.06)°vs.(3.84±1.05)°,P<0.05]。术后即刻[(3.25±1.25)°vs.(2.45±1.25)°,P<0.05]和出院时[(2.59±1.05)°vs.(2.04±1.01)°,P<0.05],观察组VAS评分高于对照组(P<0.05)。结论DIACF患者进行植骨前,外科医师应考虑患者预期结果、术后康复训练和患者经济状况,没必要为每例DIACF患者进行植骨。Objective To investigate the clinical necessity of autologous iliac bone transplantation for displaced intra-articular calcaneal fractures(DIACFs).Methods Sixty-two patients with DIACF admitted to our hospital from October 2020 to January 2021 were selected and divided into the control group[open reduction and internal fixation(ORIF)]and the observation group(ORIF combined with autologous iliac bone transplantation)according to the method of the randomized numerical table,with 31 cases in each group.Clinical imaging parameters including Bohler angle,Gissane angle,and heel height,width,and length were compared between the two groups based on X-rays.The foot function and pain levels were assessed by the AOFAS score and pain visual analogue scale(VAS),respectively.Results The operation time and hospital stay of the observation group were higher than that of the control group;the time of complete weight-bearing was shorter than that of the control group.At one year postoperatively,the Bohler angle of the observation group was higher than that of the control group[(26.15±3.11)vs.(24.41±3.24),P<0.05],and the angle of loss of Bohler angle was lower than that of the control group[(2.39±1.06)vs.(3.84±1.05),P<0.05].In the immediate postoperative period[(3.25±1.25)vs.(2.45±1.25),P<0.05]and at discharge[(2.59±1.05)vs.(2.04±1.01),P<0.05],the VAS of pain was higher in the observation group than in the control group.Conclusions Before bone grafting in patients with DIACF,the surgeon should consider the patient’s expected outcome,postoperative rehabilitation,and financial situation.Bone grafting is not necessary for every patient with DIACF.

关 键 词：跟骨 骨折 矫形外科手术 骨移植 

分 类 号：R683.4[医药卫生—骨科学]