微创解剖钢板及加压螺栓治疗跟骨毁损性骨折
Treatment strategies and clinical research of the calcaneus massively damaged fracture
目的 探讨应用微创解剖钢板及加压螺栓加压固定结合早期功能锻炼治疗跟骨毁损性骨折的疗效.方法 回顾性分析2004年4月至2006年10月治疗12例跟骨严重粉碎性骨折患者资料,男10例,女2例;年龄24~56岁,平均39岁;均为高处坠落致单侧跟骨SandersⅣ型骨折.采用解剖钢板及加压螺栓进行加压内固定.术后48 h即进行主动功能锻炼,4周逐渐负重活动磨造距下关节面.采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准对患足进行评价.结果 12例患者损伤后6~11 d,平均7.6 d进行手术;手术时间为56~93 min,平均78 min.术后X线片示跟骨的高度、长度、宽度、外形及后足的力线轴基本得到恢复,B(o)hler角由术前19.6°±1.9°恢复至术后24.5°±3.7°.12例患者均获得随访,随访时间为66~87个月,平均76个月.术后7例距下关节后关节面移位<3mm,其余5例移位>3 mm.1例术后发生伤口浅表感染,经延期换药后伤口愈合.末次随访时,2 km徒步行走后,2例存在轻度疼痛,1例存在中度疼痛,余均无疼痛.AOFAS评分为65~94分,平均82分;其中优4例,良5例,可2例,差1例;优良率为75%(9/12).结论 应用微创解剖钢板及加压螺栓加压固定结合早期功能锻炼治疗跟骨毁损性骨折术后效果优良.
更多Objective To explore the preliminary results of the treatment for calcaneus massively damaged fracture by an anatomic plate and compression bolts,following by early exercise.Methods The date of 12 patients with severely comminuted fracture of unilateral calcaneus was retrospectively analyzed who received treatment from April 2004 to October 2006.There were 10 males and 2 females with an average age of 39 years (range,24-56 years).All patients had unilateral fracture of calcaneus as a result of falling down from the height,and all types of the fractures were Sanders IV.The patients were treated with an anatomic plate and compression bolts.The functional recovery was evaluated by using the American Orthopaedic Foot and Ankle Society (AOFAS) scores.Results There was an average of 7.6 days (range,6-11 days) before the operations were performed in 12 cases.The average operation time was 78 mins (range,56-93 mins).Supervised functional exercise began 48 hours after the operation.Progressively earlier weight-bearing commenced 4 weeks after surgery to mould the subtalar joint.During the following-up,the restoration of the height,length,width,normal outline of the calcaneus and the mechanical axis of the hindfoot were observed on the radiographs.The B(o)hler angle of the affected calcaneus was improved to 24.5°±3.7°.All patients were followed up for an average of 76 months (range,66-87 months).Displacement of less than 3 mm was noted in 7 cases and more than 3 mm displacement was noted in the other five.Postoperative superficial infections occurred in one case.At the last follow-up,2 patients felt mild pain,one felt moderate pain and the others felt no pain after two-kilometer walking.The mean AOFAS score was 82 (range,65-94),and the overall results were good or excellent in 9/12 (75%) including excellent results in 4 cases,good in 5,fair in 2,and poor in 1.Conclusion The treatment for calcaneal massively damaged fractures by an anatomic plate and compression bolts followed by early exercise to mould the subtalar joint achieves good effect.
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