摘要
目的：探讨术前 CT 扫描指导跟骨骨折闭合复位术中固定方式的临床意义。方法对拟行手术的 SandersⅡ～Ⅲ型跟骨骨折患者36例，分为闭合复位空心螺钉内固定组18例、切开复位钢板内固定组18例，对闭合复位内固定进行患侧 CT 扫描，了解骨折具体移位形态，指导术中螺钉植入方式，并对术后3 d 及术后6个月的跟骨 bohler’s 角及跟骨高度进行测量、比较，并对跟骨功能进行 AOFAS（美国足踝外科学会踝—后足评分标准）评分。结果闭合复位空心螺钉内固定组术后第3天bohler’s 角25．3°～40°（34．8±5．12°），跟骨高度41～54 mm（47．5±3．94 mm），术后6个月 bohler’s 角25．4°～39．8°（34．7°±5．15°），跟骨高度40～54 mm（47．4±5．29 mm），术后6月 AOFAS 评分优15足，良2足，可1足，优良率94．4％，切开复位钢板内固定组术后3 d bohler’s 角26．3°～39．6°（34．8°±5．24°），跟骨高度35．5～53．5 mm（47．6±5．25 mm），术后6个月bohler’s 角26．2°～39．7°（34．7°±5．24°），跟骨高度35．3～53．4 mm（47．5±5．29 mm），术后6月 AOFAS 评分优13足，良3足，可2足，优良率88．9％，两组组内比较有统计学差异（P ＜0．05），组间比较，跟骨高度和 bohler’s 角角度测量结果无统计学差异。结论闭合复位空心螺钉内固定术前 CT 平扫，可以直观的了解跟骨折的具体移位情况，可以更加准确的复位及调整螺钉的布局，符合骨折复位、固定的基本原则，术后关节面塌陷及骨折再移位较切开复位内固定无统计学差异，但减少了切开复位的手术并发症，提高了临床疗效。
Objective To discuss the clinical value of different fixation methods in calcaneal fracture closed reduction internal fixation surgery guided by preoperative CT scan.Methods We chose 36 sandersⅡ ～Ⅲ calcaneal fracture patients and divided them into two groups （closed reduction group and open reduction group）.18 patients were treated with hollow screws after closed reduction and the rest were treated with plates and screws after open reduction.The closed reduction group patients received preoperative CT scan to in-vestigate the displacement situation to guide the fixation way of hollow screws.We measured the calcaneal Bohlerangle and the height of calcaneal and compared them between the two groups 3 days and 6 months after the surgery.The calcaneal function was evaluated by AOFAS.Results In the closed reduction group,the bohler angle was 25.3°～40°（34.8°±5.12°）and the height of calcaneal was 41～54mm （47.5 ±3.94mm）3 days after the surgery.The bohler angle was 25.4°～39.8°（34.7°±5.15°）and the height of calcaneal was 40 ～54 mm （47.4 ±5.29 mm）6 months after the surgery.15 patients were in excellent codition,2 were good,1 was fair through the AOFAS scoring system 6 months after the surgery.In the open reduction group,the bohler angle was 26.3°～39.6°（34.8°± 5.24°）and the height of calcaneal was 35.5 ～53.5 mm （47.6 ±5.25 mm）3 days after the surgery.The bohler angle was 26.2°～39.7°（34.7°±5.24°）and the height of calcaneal was 35.3 ～53.4 mm （47.5 ±5.29 mm）6 months after the surgery.13 patients were in excellent condition,3 were good,2 was fair through the AOFAS scoring system 6 months after the surgery.The measure results of the bohler angle and the height of calcaneal between the two groups were not significantly different （P 〉0.05）.Conclusions The preoperative CT scan could directly observe the displacement situation,and guided the accurate reduction and screws arrangement.This accorded with the fundamental principle of reduction and fixa
出处
《安徽医药》
CAS
2015年第8期1515-1518,共4页
Anhui Medical and Pharmaceutical Journal
关键词
跟骨骨折
闭合复位内固定
CT
平扫
calcaneal fracture
closed reduction internal fixation
CT scan
