跟骨骨折术后疗效分析
发布时间：2018-12-18 15:09
【摘要】：背景：跟骨骨折在跗骨骨折中较为常见，在跗骨骨折中，约60%~65%为跟骨骨折，而且多可伤及距下关节跟骨骨折多由高处坠落ǐ足跟受到撞击所致跟骨是由一层薄的骨皮质壳包裹着的松质骨，当距骨向下冲击跟骨时会发生跟骨骨折由于跟骨解剖结构特殊ǐ周围软组织血运差ǐ骨折时对周围组织冲击力大，因此术后并发症较多 跟骨在人体行走与维持身体稳定方面起着重要作用，，因此精确的处理跟骨骨折十分重要随着近些年对后足部生物力学的深入研究以及医学技术的迅速发展，跟骨骨折的治疗水平及骨折预后都在逐渐提高目前根据骨折情况，手术治疗方式较多，通过外侧入路行切开复位内固定术治疗跟骨骨折已被广泛应用，其中外侧扩大L形切口较为常见在众多关节内骨折中，跟骨骨折术后并发症明显高于其他部位，因此，如何既能恢复跟骨解剖复位，又能降低跟骨骨折并发症发生率，成为当今跟骨骨折治疗的主要话题 目的：对外侧L型切口治疗跟骨骨折术后疗效及相关并发症进行分析，得出可能影响跟骨骨折术后疗效的有关因素 方法：采用回顾性分析方法，选取我院2009年6月至2013年10月期间收治的131例168足闭合性跟骨骨折，其中男性104人，女性27人，年龄18-70岁，平均40.5岁，均通过外侧L型切口切开复位内固定术治疗，对术后相关并发症以及术后疗效进行分析在统一围手术期及术后处理的前提下，收集患者骨折类型，受伤致手术时间间隔，术前ǐ术后Bohler’s角与Gissane角等相关信息，门诊复查及电话随访6个月至52个月，平均28.6个月应用Maryland足部评分标准进行评分通过SPSS17.0软件对引起相关结果进行数据方差分析，当P＜0.05时，有统计学意义 结果：131名患者均受到随访，骨折均骨性愈合，无骨不连术后出现切口并发症28例，25例经换药ǐ抗生素治疗后4周左右拆线；骨髓炎3例，经抗生素骨水泥填充后愈合;出现创伤性距下关节炎34足受伤至手术时间与术后切口并发症关系有统计学意义术前ǐ术后Bohler’s角和Gissane角对比有统计学意义根据Maryland足部评分标准，跟骨骨折术后优良率为79.8%跟骨骨折术后多于术后1~2年内出现创伤性距下关节炎，占所有距下关节炎的64.7%；Sanders IV型跟骨骨折术后创伤性关节炎发生率可达50% 结论：1ǐ通过外侧L型切口行切开复位内固定术治疗跟骨骨折术后疗效较好；2ǐ对于手术时机的选择，应尽量避免伤后8小时-7天内行手术切开复位内固定术治疗；对于SandersIV型跟骨骨折，尽量将手术推迟到7天以后，可有效降低切口并发症发生率；3ǐBohler’s角ǐGissane角与跟骨骨折损伤程度有关，且对跟骨外形恢复有指导意义；4ǐ随着跟骨骨折程度的加重，术后足部功能评分相应降低；5ǐ跟骨骨折术后创伤性关节炎多发生于术后1~2年内，且Sanders IV型跟骨骨折术后出现创伤性关节炎概率较高
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前1条
1 邢科;袁峰;;撬拔复位治疗跟骨骨折疗效评定和后遗症原因分析[J];陕西医学杂志;2008年07期
本文编号：2386025
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2386025.html
最近更新
教材专著
