摘要
目的评价同种异体骨移植治疗移位关节内跟骨骨折(displaced intra-articular calcaneal fractures,DIACFs)的疗效。方法2005年1月-2007年12月,应用经外侧小切口开放复位,解剖钢板内固定,同种异体骨移植治疗DIACFs28例(34足)。其中男18例,女10例;年龄16～65岁,中位年龄38.5岁。根据Sanders分型,Ⅱ型18足,Ⅲ型10足,Ⅳ型6足。受伤至手术时间2h～18d。结果22例(28足)获随访13～28个月,平均18.5个月。26足切口Ⅰ期愈合;2足出现排斥反应,均行二次手术,取出内固定,并应用外固定支架固定,切口闭合冲洗,静脉应用抗生素,局部换药治疗,1足切口Ⅰ期愈合,1足延期愈合。获随访的22例(28足)术前Bhler角为(6.19±9.66)°,术后即刻为(34.51±5.89)°;术前Gissane角为(103.04±15.03)°,术后即刻为(112.18±10.50)°;各指标手术前、后比较差异均有统计学意义(P<0.05)。12例(14足)术后6～10个月取出内固定,取出内固定后Bhler角为(32.81±5.10)°,Gissane角为(110.81±9.98)°,与术前比较差异有统计学意义(P<0.05),与正常值比较差异无统计学意义(P>0.05)。根据美国骨科足踝外科学会的踝-后足评分标准评分:60～70分3足,70～80分10足,80～90分12足,90～100分3足。结论应用同种异体骨移植治疗DIACFs,可有效填充缺损区,维持复位后跟骨的高度及后侧面解剖复位,加速骨愈合,较好地恢复足功能。
Objective To investigate the operative treatment of displaced intra-articular calcaneal fractures （DIACFs） using a combination of small lateral incision approach and internal fixation and allograft bone transplantation. Methods From January 2005 to December 2007, 28 patients with 34 DIACFs were treated with open reduction, allograft bone transplantation and internal fixation through a small lateral incision approach. Of them, there were 18 males and 10 females, aged 16-65 years. The disease course was 2 hours to 18 days. According to Sanders classification, there were 18 cases of type II fractures, 10 cases of type III fractures and 6 cases of type IV fractures. Results 22 patients with 28 DIACFs were followed up 18.5 months （13-28 months）. The wound of 26 feet achieved primary healing, the acute rejection was found in 2 patients and developed wound complications. Both patients underwent further surgery prior wound healing. After the internal fixation were removed, factures was fixed with external fixator, closed continuous irrigation and drainage was employed. In the meantime, both patients received antibiotics and incisional dressing change. As a result, one achieved primary healing, the other developed delayed healing. The preoperative X-ray film showed that B6hler angle was （6.19±9.66）° and Gissane angle was （103.04 ± 15.03）°; the postoperative X-ray film demonstrated that B6hler angle was （34.51 ± 5.89）° and Gissane angle was （112.18 ± 10.50）°; showing statistically significant differences （P 〈 0.05）. The internal fixation of 12 patients （14 DIACFs） were removed at 6 -10 months after operation, Bohler angle was （32.81 ± 5.10）° and Gissane angle was （110.81 ± 9.98）°. When compared with preoperative X-ray film, statistically significant differences （P 〈 0.05） was found, but there was no statistically significant differences （P 〉 0.05） when compared with normal X-ray film. According to the American Orthopedic Foot and Ankle Society evaluation system for ankle-hind foot, 3 feet scored 60-70 points, 10 feet 70-80 points, 12 feet 80-90 points and 3 feet 90-100 points. Conclusion Allograft bone transplantation is an option for management of DIACFs, because it enables satisfactory reconstruction of bone defects, allows met anatomic reduction and functional recovery, maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第7期869-872,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
跟骨
关节内骨折
异体骨移植
Calcaneus Intra-articular fracture Allograft bone transplantation
