摘要
目的探讨跟骨关节内骨折畸形愈合手术治疗方法及各种方法的优、缺点。方法2002年6月至2004年3月,手术治疗跟骨关节内骨折畸形愈合28例30足,男26例28足,女2例2足;年龄23～59岁,平均39.2岁;左侧15例,右侧11例,双侧2例。受伤距手术治疗时间为2～5个月,平均3.3个月。行切开复位内固定术13例14足,行保留距下关节的跟骨截骨矫形术9例10足,行跟骨丘部重建距下关节融合术6例6足。结果28例30足中,29足皮肤切口一期愈合;1足伤口感染,经恒定负压吸引、换药后愈合。随访时间10～29个月,平均15.6个月,无一例发生截骨、关节融合植骨不愈合。平均愈合时间为2.5个月,完全负重时间为3个月。分别在手术前、后跟骨侧位及轴位X线片和CT片上测量B!hler角、Gissane角、跟骨的宽度及轴长、跟骨体-丘部高度并进行比较,手术前、后各指标相比差异均有统计学意义(均P<0.01)。按美国足踝外科协会Maryland足评分系统评价手术前、后的功能:术前,可9足、差21足;术后,优7足、良19足、可3足、差1足;优良率为86.7%。Maryland评分术前为32分,术后为83分,平均改善51分。结论手术治疗跟骨关节内骨折畸形愈合时,应根据其病理特点,合理地选择手术方法。
Objective To discuss three methods to treat intra-articular calcaneal fractures with malunion, and to investigate the indications and significances of the operative treatment. Methods From June 2002 to March 2004, 28 intra-articular calcaneal fractures with malunion patients （26 males and 2 fe- males, 30 feet） suffered operations. The average age of these patients was 39.2 years old （range, 23-59 years）. The malunion happened at left feet in 15 patients, right feet in 11, and bilateral feet in 2. The mean duration between injury and operation was 3.3 months （range, 2-5 months）. All cases used improved ＂L＂ incisions at lateral of heels. 13 patients （14 cases） did open reduction and internal fixation; 9 patients （10 cases） operated calcaneal osteotomy to reserve subtalar joint and correct deformity with apophysis excision, then used internal fixations; 6 patients （6 cases） used correct deformity with apophysis excision, calcaneal cumulus reconstruction and subtalar arthrodesis. The calcaneal lateral and axial X-ray and CT films were got to measure the Boehler angle, Gissane angle, calcaneal width and axial length, and height of calcaneal bedythalamic portion before and after operation. There were siginificant differences at all index before and after operation （P〈 0.01）. Results 29 feet in 30 feet were primarily healing, one infective foot delayed healed after treatment. The follow-up period was from 10 months to 29 months （average 15.6 months）. According to American Orthopaedic Foot and Ankle Society （AOFAS） Maryland score＇s standard： 7 cases were excellent, 19 cases were good, 3 cases were fair, and only 1 case was poor. The score was 32 preoperatively, 83 postoperatively, the average improvement was 51. The excellent and good rate was 86.7%. Conclusion The operations of intra-articular calcaneal fractures with malunion should be chosen according to the pathological character of deformity to get significant curative effects.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第2期82-85,共4页
Chinese Journal of Orthopaedics
关键词
跟骨
骨折
连接错位
外科手术
Calcaneus
Fractures, malunited
Surgical procedures, operative
