跟骨骨折術(shù)后療效分析
發(fā)布時(shí)間：2018-12-18 15:09
【摘要】：背景：跟骨骨折在跗骨骨折中較為常見，在跗骨骨折中，約60%~65%為跟骨骨折，而且多可傷及距下關(guān)節(jié)跟骨骨折多由高處墜落ǐ足跟受到撞擊所致跟骨是由一層薄的骨皮質(zhì)殼包裹著的松質(zhì)骨，當(dāng)距骨向下沖擊跟骨時(shí)會(huì)發(fā)生跟骨骨折由于跟骨解剖結(jié)構(gòu)特殊ǐ周圍軟組織血運(yùn)差ǐ骨折時(shí)對(duì)周圍組織沖擊力大，因此術(shù)后并發(fā)癥較多 跟骨在人體行走與維持身體穩(wěn)定方面起著重要作用，，因此精確的處理跟骨骨折十分重要隨著近些年對(duì)后足部生物力學(xué)的深入研究以及醫(yī)學(xué)技術(shù)的迅速發(fā)展，跟骨骨折的治療水平及骨折預(yù)后都在逐漸提高目前根據(jù)骨折情況，手術(shù)治療方式較多，通過外側(cè)入路行切開復(fù)位內(nèi)固定術(shù)治療跟骨骨折已被廣泛應(yīng)用，其中外側(cè)擴(kuò)大L形切口較為常見在眾多關(guān)節(jié)內(nèi)骨折中，跟骨骨折術(shù)后并發(fā)癥明顯高于其他部位，因此，如何既能恢復(fù)跟骨解剖復(fù)位，又能降低跟骨骨折并發(fā)癥發(fā)生率，成為當(dāng)今跟骨骨折治療的主要話題 目的：對(duì)外側(cè)L型切口治療跟骨骨折術(shù)后療效及相關(guān)并發(fā)癥進(jìn)行分析，得出可能影響跟骨骨折術(shù)后療效的有關(guān)因素 方法：采用回顧性分析方法，選取我院2009年6月至2013年10月期間收治的131例168足閉合性跟骨骨折，其中男性104人，女性27人，年齡18-70歲，平均40.5歲，均通過外側(cè)L型切口切開復(fù)位內(nèi)固定術(shù)治療，對(duì)術(shù)后相關(guān)并發(fā)癥以及術(shù)后療效進(jìn)行分析在統(tǒng)一圍手術(shù)期及術(shù)后處理的前提下，收集患者骨折類型，受傷致手術(shù)時(shí)間間隔，術(shù)前ǐ術(shù)后Bohler’s角與Gissane角等相關(guān)信息，門診復(fù)查及電話隨訪6個(gè)月至52個(gè)月，平均28.6個(gè)月應(yīng)用Maryland足部評(píng)分標(biāo)準(zhǔn)進(jìn)行評(píng)分通過SPSS17.0軟件對(duì)引起相關(guān)結(jié)果進(jìn)行數(shù)據(jù)方差分析，當(dāng)P＜0.05時(shí)，有統(tǒng)計(jì)學(xué)意義 結(jié)果：131名患者均受到隨訪，骨折均骨性愈合，無骨不連術(shù)后出現(xiàn)切口并發(fā)癥28例，25例經(jīng)換藥ǐ抗生素治療后4周左右拆線；骨髓炎3例，經(jīng)抗生素骨水泥填充后愈合;出現(xiàn)創(chuàng)傷性距下關(guān)節(jié)炎34足受傷至手術(shù)時(shí)間與術(shù)后切口并發(fā)癥關(guān)系有統(tǒng)計(jì)學(xué)意義術(shù)前ǐ術(shù)后Bohler’s角和Gissane角對(duì)比有統(tǒng)計(jì)學(xué)意義根據(jù)Maryland足部評(píng)分標(biāo)準(zhǔn)，跟骨骨折術(shù)后優(yōu)良率為79.8%跟骨骨折術(shù)后多于術(shù)后1~2年內(nèi)出現(xiàn)創(chuàng)傷性距下關(guān)節(jié)炎，占所有距下關(guān)節(jié)炎的64.7%；Sanders IV型跟骨骨折術(shù)后創(chuàng)傷性關(guān)節(jié)炎發(fā)生率可達(dá)50% 結(jié)論：1ǐ通過外側(cè)L型切口行切開復(fù)位內(nèi)固定術(shù)治療跟骨骨折術(shù)后療效較好；2ǐ對(duì)于手術(shù)時(shí)機(jī)的選擇，應(yīng)盡量避免傷后8小時(shí)-7天內(nèi)行手術(shù)切開復(fù)位內(nèi)固定術(shù)治療；對(duì)于SandersIV型跟骨骨折，盡量將手術(shù)推遲到7天以后，可有效降低切口并發(fā)癥發(fā)生率；3ǐBohler’s角ǐGissane角與跟骨骨折損傷程度有關(guān)，且對(duì)跟骨外形恢復(fù)有指導(dǎo)意義；4ǐ隨著跟骨骨折程度的加重，術(shù)后足部功能評(píng)分相應(yīng)降低；5ǐ跟骨骨折術(shù)后創(chuàng)傷性關(guān)節(jié)炎多發(fā)生于術(shù)后1~2年內(nèi)，且Sanders IV型跟骨骨折術(shù)后出現(xiàn)創(chuàng)傷性關(guān)節(jié)炎概率較高
[Abstract]:Background: calcaneal fractures are more common in tarsal fractures, about 60% of which are calcaneal fractures. And most of the calcaneal fractures that can injure the subtalar joint are the calcaneal bones that are wrapped in a thin cortical shell of the calcaneus, which is caused by a fall from the height of the calcaneal calcaneum. Calcaneal fracture occurs when the talus hits the calcaneus downward because of the special anatomical structure of the calcaneus and the poor blood flow around the soft tissue, it has a great impact on the surrounding tissues. Therefore, the postoperative complications of calcaneus play an important role in human walking and maintaining physical stability. Therefore, it is very important to deal with calcaneal fracture accurately. With the deep research of posterior foot biomechanics and the rapid development of medical technology in recent years, the treatment level and fracture prognosis of calcaneal fracture are gradually improving according to the fracture situation. The treatment of calcaneal fracture by open reduction and internal fixation via lateral approach has been widely used, in which the lateral extended L-shaped incision is more common in many intra-articular fractures. The postoperative complications of calcaneal fractures were significantly higher than those of other sites. Therefore, how to restore anatomic reduction of calcaneus and reduce the incidence of complications of calcaneal fractures, Objective: to analyze the curative effect and related complications of lateral L-incision in the treatment of calcaneal fracture. Methods: 131 cases (104 males and 27 females) with closed calcaneal fractures treated in our hospital from June 2009 to October 2013 were selected by retrospective analysis. The patients aged 18-70 years (mean 40.5 years) were treated with open reduction and internal fixation through lateral L-incision. The complications and the curative effect were analyzed under the premise of unified perioperative period and postoperative management. The data of fracture type, operation interval, Bohler's angle and Gissane angle before and after operation were collected. The outpatient follow-up and telephone follow-up were conducted for 6 months to 52 months. On average, Maryland foot score was used for 28.6 months. The results were analyzed by SPSS17.0 software. When P < 0. 05, there were statistically significant results: 131 patients were followed up. There were no postoperative incision complications in 28 cases, 25 cases were removed about 4 weeks after treatment with antibiotics. 3 cases of osteomyelitis healed after filling with antibiotic bone cement. The relationship between the injury time and postoperative incision complications in 34 patients with traumatic subtalar arthritis there were significant differences between preoperative and postoperative Bohler's angle and Gissane angle according to the standard of Maryland foot score. The excellent and good rate of calcaneal fracture after operation was 79.8%, which was more than that of traumatic subtalar arthritis within 1 ~ 2 years after operation, accounting for 64.7% of all subtalar arthritis. The incidence of traumatic arthritis after Sanders IV type calcaneal fracture was 50%. Conclusion: 1 the treatment of calcaneal fracture with open reduction and internal fixation through lateral L-incision is effective; (2) for the choice of operation time, open reduction and internal fixation should be avoided within 8 hours to 7 days after injury, and for SandersIV type calcaneal fracture, the rate of incision complications could be reduced by delaying the operation to 7 days as far as possible. (3) the Gissane angle of Bohler's angle is related to the degree of calcaneal fracture injury, and it has guiding significance to the recovery of calcaneal shape, 4 with the severity of calcaneal fracture, the score of foot function decreases correspondingly after operation. Traumatic arthritis occurred within 1 ~ 2 years after the operation of 5 calcaneal fractures, and the probability of traumatic arthritis after Sanders IV calcaneal fractures was higher.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2386025
[Abstract]:Background: calcaneal fractures are more common in tarsal fractures, about 60% of which are calcaneal fractures. And most of the calcaneal fractures that can injure the subtalar joint are the calcaneal bones that are wrapped in a thin cortical shell of the calcaneus, which is caused by a fall from the height of the calcaneal calcaneum. Calcaneal fracture occurs when the talus hits the calcaneus downward because of the special anatomical structure of the calcaneus and the poor blood flow around the soft tissue, it has a great impact on the surrounding tissues. Therefore, the postoperative complications of calcaneus play an important role in human walking and maintaining physical stability. Therefore, it is very important to deal with calcaneal fracture accurately. With the deep research of posterior foot biomechanics and the rapid development of medical technology in recent years, the treatment level and fracture prognosis of calcaneal fracture are gradually improving according to the fracture situation. The treatment of calcaneal fracture by open reduction and internal fixation via lateral approach has been widely used, in which the lateral extended L-shaped incision is more common in many intra-articular fractures. The postoperative complications of calcaneal fractures were significantly higher than those of other sites. Therefore, how to restore anatomic reduction of calcaneus and reduce the incidence of complications of calcaneal fractures, Objective: to analyze the curative effect and related complications of lateral L-incision in the treatment of calcaneal fracture. Methods: 131 cases (104 males and 27 females) with closed calcaneal fractures treated in our hospital from June 2009 to October 2013 were selected by retrospective analysis. The patients aged 18-70 years (mean 40.5 years) were treated with open reduction and internal fixation through lateral L-incision. The complications and the curative effect were analyzed under the premise of unified perioperative period and postoperative management. The data of fracture type, operation interval, Bohler's angle and Gissane angle before and after operation were collected. The outpatient follow-up and telephone follow-up were conducted for 6 months to 52 months. On average, Maryland foot score was used for 28.6 months. The results were analyzed by SPSS17.0 software. When P < 0. 05, there were statistically significant results: 131 patients were followed up. There were no postoperative incision complications in 28 cases, 25 cases were removed about 4 weeks after treatment with antibiotics. 3 cases of osteomyelitis healed after filling with antibiotic bone cement. The relationship between the injury time and postoperative incision complications in 34 patients with traumatic subtalar arthritis there were significant differences between preoperative and postoperative Bohler's angle and Gissane angle according to the standard of Maryland foot score. The excellent and good rate of calcaneal fracture after operation was 79.8%, which was more than that of traumatic subtalar arthritis within 1 ~ 2 years after operation, accounting for 64.7% of all subtalar arthritis. The incidence of traumatic arthritis after Sanders IV type calcaneal fracture was 50%. Conclusion: 1 the treatment of calcaneal fracture with open reduction and internal fixation through lateral L-incision is effective; (2) for the choice of operation time, open reduction and internal fixation should be avoided within 8 hours to 7 days after injury, and for SandersIV type calcaneal fracture, the rate of incision complications could be reduced by delaying the operation to 7 days as far as possible. (3) the Gissane angle of Bohler's angle is related to the degree of calcaneal fracture injury, and it has guiding significance to the recovery of calcaneal shape, 4 with the severity of calcaneal fracture, the score of foot function decreases correspondingly after operation. Traumatic arthritis occurred within 1 ~ 2 years after the operation of 5 calcaneal fractures, and the probability of traumatic arthritis after Sanders IV calcaneal fractures was higher.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 邢科;袁峰;;撬拔復(fù)位治療跟骨骨折療效評(píng)定和后遺癥原因分析[J];陜西醫(yī)學(xué)雜志;2008年07期
本文編號(hào)：2386025
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