摘要
目的探讨三维形态学测量在老年跟骨关节内骨折诊治中的应用价值。方法采用回顾性病例系列研究分析2015年1月—2018年1月同济大学附属东方医院收治的44例老年跟骨关节内骨折患者临床资料,其中男33例,女11例;年龄60~88岁,平均67.2岁。根据Sanders分型:Ⅱ型35例,Ⅲ型9例。均行三维形态学测量评估跟骨后关节面损伤情况后,采用切开复位内固定术治疗。记录手术时间、术中出血量、术中透视次数、内固定更换情况,并观察术后并发症情况。比较术前和末次随访时跟骨的三维形态学参数,包括跟骨水平长度、跟骨后关节面高度、跟骨前部长度及高度、Gissane角、Böhler角。采用视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分评估临床疗效。结果患者均获随访12~30个月,平均17.1个月。31例跟骨后关节面塌陷>2 mm,13例跟骨体及后关节面外侧部整体后移>3 mm,均伴有跟骨外侧壁骨折。手术时间55~105 min,平均85.1 min。术中出血量30~130 ml,平均74.9 ml。术中C形臂X线机透视5~8次,平均6.5次。术中均未更换内固定。术后2例出现皮肤切口感染。末次随访的跟骨水平长度[(76.9±4.1)mm]、后关节面高度[(24.2±2.1)mm]、Gissane角[(124.8±7.2)°]、Böhler角[(29.0±6.2)°]较术前[(75.5±5.2)mm、(22.5±2.9)mm、(107.6±8.5)°、(18.3±5.5)°]均有明显改善(P<0.01)。而跟骨前部长度及高度与术前比较差异均无统计学意义(P>0.05)。末次随访时VAS[(1.1±0.9)分]和AOFAS踝-后足评分[(86.4±6.2)分]较术前[(4.4±0.9)分、(49.9±6.3)分]明显改善(P<0.01)。其中AOFAS踝-后足功能评分优13例,良26例,一般5例,优良率为87%。结论三维形态学测量可充分评估跟骨骨折的损伤情况,为老年跟骨关节内骨折切开复位内固定术的术前设计提供数据参考,进而有效恢复跟骨的解剖形态、缓解疼痛及改善踝关节功能。
Objective To investigate the application value of three-dimensional morphological measurement in the treatment of displaced intra-articular calcaneal fractures in the elderly.Methods A retrospective case series study was conducted to analyze the clinical data of 44 patients with displaced intra-articular calcaneal fractures admitted to East Hospital Affiliated to Tongji University from January 2015 to January 2018.There were 33 males and 11 females,aged 60-88 years(mean,67.2 years).According to Sanders classification,35 patients were with type II fractures and 9 with type III fractures.All patients were evaluated with digital technology and received open reduction and internal fixation.The operation time,intraoperative blood loss,intraoperative fluoroscopy frequency and complications were recorded.Three-dimensional morphological parameters of calcaneal fractures were compared before and at latest follow-up,including horizontal length of the calcaneus,height of the posterior articular facet,height and length of the anterior process,Gissane angle,and Böhler angle.The visual analogue scale(VAS)and American Orthopedic Foot and Ankle Society(AOFAS)ankle-hind foot function score were also compared.Results All patients were followed up for 12-30 months(mean,17.1 months).There were 31 patients with posterior articular facet depression more than 2 mm,and 13 patients showed the back shift of the whole or part of posterior articular facet more than 3 mm and varying degree of fracture of the upper or lateral wall part of calcaneus body.The operative time was 55-105 minutes(mean,85.1 minutes).The intraoperative blood loss was 30-130 ml(mean,74.9 ml).The intraoperative fluoroscopy frequency was 5-8 times(mean,6.5 times).During the operation,the internal fixation was not changed.Two patients suffered from skin incision infection after operation.At latest follow-up,the horizontal length of the calcaneus,height of the posterior articular facet,Gissane angle and Böhler angle were significantly improved from that before operation[(76.9±4.1)mm vs.(75.5±5.2)mm,(24.2±2.1)mm vs.(22.5±2.9)mm,(29.0±6.2)°vs.(18.3±5.5)°,(124.8±7.2)°vs.(107.6±8.5)°,respectively](P<0.01).No significance was found in the height and length of the anterior process(P>0.05).At latest follow-up,the VAS and AOFAS ankle-hind foot function score were also significantly improved compared to preoperation[(1.1±0.9)points vs.(4.4±0.9)points,(86.4±6.2)points vs.(49.9±6.3)points,respectively](P<0.01).AOFAS ankle-hind foot function score was excellent in 13 patients,good in 26,fair in 5,with the excellent and good rate of 87%.Conclusion Three-dimensional morphological measurement can fully evaluate the damage of calcaneal fractures and provide data reference for the preoperative planning of open reduction and internal fixation in the elderly,so as to restore the calcaneus structure,relieve pain and improve ankle function.
作者
王雄
强敏菲
陈雁西
张坤
贾小阳
Wang Xiong;Qiang Minfei;Chen Yanxi;Zhang Kun;Jia Xiaoyang(Department of Orthopedic Trauma,East Hospital of Tongji University,Shanghai 200120,China;Department of Orthopedic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第6期520-525,共6页
Chinese Journal of Trauma
基金
国家自然科学基金(81672141)
上海市卫生计生系统优秀学科带头人培养计划(2017BR059)。
关键词
跟骨
成像
三维
骨折固定术
内
老年
Calcaneus
Imaging
three-dimensional
Fracture fixation
internal
Elderly
