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经皮复位移位的关节内跟骨骨折后超皮锁定钢板固定的疗效

The outcome of super-cutaneous locked plate fixation with percutaneous reduction of displaced intra-articular calcaneal fractures.

作者信息

El-Desouky Ihab I, Abu Senna Wissam

机构信息

Kasr Al-Ainy School of Medicine, Faculty of Medicine, Cairo University, Egypt.

出版信息

Injury. 2017 Feb;48(2):525-530. doi: 10.1016/j.injury.2017.01.014. Epub 2017 Jan 6.

Abstract

INTRODUCTION

Supercutaneous (external) fixation with locking plate is utilized for fixation of long bone fractures. One retrospective study for open reduction and supercutaneous fixation of the calcaneus is reported. We prospectively evaluated the use of this method of fixation combined with percutaneous reduction.

MATERIALS AND METHODS

Between January 2014 and June 2015, 32 displaced calcaneus fractures in 30 patients were stabilized with percutaneous reduction and super-cutaneous fixation. They were 24 males and six females. The mean age was 37.9±5.7 years (21-55). All cases were closed. The time to surgery, complications, radiographic alignment, and time to radiographic union were recorded. Clinical results at the final follow-up were assessed by evaluating Bohler's angles for the radiographic alignment, and the system of the American Orthopedic Foot and Ankle Society (AOFAS) for the functional outcome.

RESULTS

According to the Sanders' classification, two cases were type II, 17 cases were type III and 13 cases were type IV. The preoperative average Bohler's angle was 10.57°±4.8. The postoperative X-ray films demonstrated that the average Bohler's angle improved to 29.07°±5.9 (p<0.001). At the time of radiologic healing (about 3 months), the plates and screws were removed under general anesthesia. The average follow-up was 13.2 months (11-18). Four cases (type IV) showed mal-union and heel pain. According to (AOFAS) rating, the fine score was 87.1±17.1 points.

CONCLUSION

Super-cutaneous fixation with percutaneous reduction of calcaneal fracture is an effective method in type II and III and can be effective with type IV but with less favorable results.

摘要

引言

锁定钢板皮下(外)固定用于长骨骨折的固定。本文报道了一项关于跟骨切开复位及皮下固定的回顾性研究。我们前瞻性地评估了这种固定方法结合经皮复位的应用。

材料与方法

2014年1月至2015年6月期间,对30例患者的32例移位跟骨骨折采用经皮复位及皮下固定进行稳定治疗。其中男性24例,女性6例。平均年龄为37.9±5.7岁(21 - 55岁)。所有病例均为闭合性骨折。记录手术时间、并发症、影像学对线情况以及影像学愈合时间。末次随访时的临床结果通过评估Bohler角的影像学对线情况以及美国矫形足踝协会(AOFAS)系统的功能结果进行评估。

结果

根据Sanders分类,Ⅱ型2例,Ⅲ型17例,Ⅳ型13例。术前平均Bohler角为10.57°±4.8。术后X线片显示平均Bohler角改善至29.07°±5.9(p<0.001)。在影像学愈合时(约3个月),在全身麻醉下取出钢板和螺钉。平均随访13.2个月(11 - 18个月)。4例(Ⅳ型)出现畸形愈合和足跟疼痛。根据(AOFAS)评分,优良率为87.1±17.1分。

结论

经皮复位跟骨骨折的皮下固定对Ⅱ型和Ⅲ型骨折是一种有效的方法,对Ⅳ型骨折也可能有效,但效果稍差。

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