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影响移位关节内跟骨骨折手术疗效的因素

Factors influencing the operative results of displaced intra-articular calcaneal fracture

摘要:

目的 探讨影响移位关节内跟骨骨折(DIACF)切开复位内固定手术疗效的相关因素. 方法 2009年5月-2013年6月共手术治疗DIACF患者80例(91足),其中男68例(77足),女12例(14足);年龄18 ~72岁(平均38.7岁).根据可能影响手术疗效的因素,如骨折Sanders分型、复位质量、术后B(o)hler角、术后跟骨宽度、伤后手术时间、年龄等进行分组统计.结果 患者平均随访18.3个月(14~ 26个月).手术疗效:优67足(74%),良12足(13%),可7足(8%),差5足(5%),优良率为87%.临床优良率在骨折不同类型组分别为SandersⅡ型94%、Ⅲ型85%和Ⅳ型53%;在关节面复位质量≤2 mm和>2 mm组分别为93%和30%;在术后B(o)hler角<15°和≥15°组分别为33%和90%;在术后跟骨增宽<1 cm和≥1 cm组分别为92%和17%;在伤后手术时间≤14 d和>14 d组分别为91%和43%;在年龄≤60岁和>60岁组分别为85%和88%.以上各因素的手术疗效比较,除年龄组间差异无统计学意义外,其余各因素差异均有统计学意义(P<0.05). 结论 骨折类型、复位质量、术后B(o)hler角、术后跟骨宽度、伤后手术时间等因素均对移位关节内跟骨骨折手术疗效产生显著影响,应避免不利因素,提高手术疗效.

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abstracts:

Objective To determine the factors influencing the results of open reduction and internal fixation for displaced intra-articular calcaneal fracture (DIACF).Methods From May 2009 to June 2013, 80 patients with DIACF involving in 91 feet were treated by open reduction and internal fixation.Mean age was 38.7 years (range, 18-72 years).Patients were grouped according to the possible factors related to the operative results, including the Sanders classification of fracture, quality of fracture reduction, postoperative B(o)hler angle, width of postoperative calcaneus, and time to surgery after injury.Clinical result was evaluated and compared within each group.Results Mean duration of follow-up was 18.3 months (range, 14-26 months).The clinical results were excellent for 67 feet (74%), good for 12 feet (13%), fair for 7 feet (8%) and poor for 5 feet (5%), which yielded 87% good to excellent results.Good to excellent results in Sanders Ⅱ , Ⅲ and Ⅳ groups reached 94%, 85% and 53% respectively, in quality of fracture reduction ≤ 2 mm and > 2 mm groups reached 93% and 30% respectively, in postoperative B(o)hler angle < 15° and ≥15° groups reached 33% and 90% respectively;in broadening of postoperative calcaneus < 1 cm and ≥ 1 cm groups reached 92% and 17% respectively, in time to surgery after injury ≤14 days and > 14 days groups reached 91% and 43% respectively, in age ≤60 years old and > 60 years old groups reached 85% and 88% respectively.Except for the age group, the clinical result differed significantly within group (P < 0.05).Conclusions Fracture type, reduction quality, postoperative B(o)hler angle, width of postoperative calcaneus, time to surgery after injury are the factors influencing on the operative results of patients with displaced intra-articular calcaneal fracture.Thereupon the unfavorable influences should be avoided to improve the operative results.

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