摘要
目的评价植骨在跟骨关节内骨折切开复位钢板内固定手术治疗中的价值。方法2005年1月至2011年8月，接受切开复位钢板内固定手术治疗的跟骨关节内骨折182例。男159例，女23例；平均41．2岁。单纯左侧跟骨骨折68例，单纯右侧跟骨骨折86例，双侧跟骨骨折28例，均为闭合骨折。骨折根据Sander分型：Ⅱ型27例，Ⅲ型109例，Ⅳ型46例。182例患者分为植骨组（94例）、未植骨组（88例），分型比较差异有统计学意义（P〈0．05）。手术均应用跟骨外侧切口，切开复位异型钢板内固定术。采用美国足踝外科学会（AOFAS）评分行足踝功能评分。结果lO例患者3个月后失随访，172例获得随访，随访时间平均14．2个月。骨折愈合时间8-15周，平均12周，骨折均愈合，无神经损伤，骨髓炎。未植骨组29例负重后关节面出现塌陷，21例合并距下关节创伤性关节炎。植骨组未出现关节面塌陷，1例合并距下关节创伤性关节炎。植骨组优68例，良20例，可5例，差1例；未植骨组优44例，良26例，可7例，差9例，优良率为87．9％。两组术后的AOFAS评分比较差异有统计学意义（P〈0．05）。结论植骨对提高跟骨关节内骨折手术疗效有重要意义。
Objective To evaluate the efficacies of treating intra-calcaneal fractures with bone grafting. Methods From January 2005 to October 2011, a total of 182 calcaneal patients underwent operations for closed fractures. There were 159 males and 23 females with an average age of 41.2 years old. The fractures were of the following types ： left calcaneal （ n = 68 ）, fight calcaneal （ n = 86 ） and bilateral （n =28）. According to the Sander＇s classification, there were type II （n =27）, type Ill （n = 109） and type IV （n = 46）. And they were divided into bone graft （n = 94） and non-bone graft （n = 88 ） groups. Allof them underwent a profiled plate fixation via a lateral approach. No external fixation was necessary and early ankle functional exercises started postoperatively. They handled partial weight-bearing at Week 6 and full weight-bearing at Week 12. Their outcomes were assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scale （AOFAS） while classification comparison affected the prognosis （P 〈 0. 05）. Results The follow-ups of 10 patients were lost at Month 3. And 172 cases were followed up for an average period of 14. 2 months （range ：9 - 16）. The average healing duration was 12 weeks （ range ：6 - 15）. None of follow-up cases had any complication, such as vascular and nerve injury and osteomyelitis. Twenty- nine cases in the non-bone graft group had articular cave-in after weight bearing. And 21 cases were associated with subtalus arthritis. And in the bone graft group, there was no articular cave-in and only 1 case was associated with subtalus arthritis. The outcomes of bone graft and non-graft groups were as follows： excellent （n =68）, good （n =20）, fair （n =5） and poor （n = 1） vs. excellent （n =44）, good （n =26）, fair （n = 7） and poor （n = 9）. The rate of excellent and good was 87. 9%. And the post-operative AOFAS scores had statistical differences between 2 groups （P 〈 0.05）. Conclusion Bone grafting is important for improving the therapeutic efficacies for intra-calcaneal fractures.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第3期197-199,共3页
National Medical Journal of China
关键词
骨折固定术
内
跟骨
骨移植
Fracture fixation,internal
Calcaneus
Bone transplantation
