| 严重跟骨骨折手术时机选择的临床研究 |
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投稿时间：2006-08-22
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| 作者 | Author | 单位 | Address | E-Mail |
| 张俊杰 |
ZHANG Jun-jie |
杭州市余杭区第三人民医院,浙江杭州311115 |
The 3rd People′s Hospital of Yuhang District,Hangzhou 311115,Zhejiang,China |
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| 田耜奇 |
TIAN Si-qi |
杭州市余杭区第三人民医院,浙江杭州311115 |
The 3rd People′s Hospital of Yuhang District,Hangzhou 311115,Zhejiang,China |
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| 张坚平 |
ZHANG Jian-ping |
杭州市余杭区第三人民医院,浙江杭州311115 |
The 3rd People′s Hospital of Yuhang District,Hangzhou 311115,Zhejiang,China |
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| 孔丽萍 |
KONG Li-ping |
杭州市余杭区第三人民医院,浙江杭州311115 |
The 3rd People′s Hospital of Yuhang District,Hangzhou 311115,Zhejiang,China |
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| 杨顺华 |
YANG Shun-hua |
杭州市余杭区第三人民医院,浙江杭州311115 |
The 3rd People′s Hospital of Yuhang District,Hangzhou 311115,Zhejiang,China |
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| 期刊信息：《中国骨伤》2007年，第20卷，第5期，第307-309页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的:探讨跟骨骨折手术时机选择的必要性、优越性及足关节功能恢复状况。
方法:收治SandersⅡ、Ⅲ、Ⅳ型跟骨骨折共71例（76足）,其中男49例,女22例;年龄19~56岁,平均35.6岁;根据Sanders分类:Ⅱ型23例（24足）,Ⅲ型36例（38足）,Ⅳ型12例（14足）,均行切开复位、自体骨植骨加跟骨钢板内固定;分别于伤后8h内、伤后8h~7d内、伤后7~14d不同时期进行手术并比较手术疗效。
结果:71例（76足）,随访时间6个月~3.5年,平均19个月。术后X线片复查未见内固定松动断裂,骨折全部愈合,骨折愈合时间8~12周,平均8.5周。手术前后测量跟骨高度、跟骨宽度、Bhler角、Gissane角,测量结果比较采用配对t检验,均有显著差异（P<0.01）。伤后8h内手术组（A组）,术后并发症发生率9.7%（3/31）;伤后8h~7d内手术组（B组）,术后并发症发生率41.2%（7/17）;伤后7~14d手术组（C组）,术后并发症发生率10.7%（3/28）,经统计学处理（χ2检验）显示A组、C组与B组在术后并发症的发生上比较有显著差异（P<0.05）,但A组与C组在术后并发症的发生上比较无显著差异（P>0.05）。按Kerr术后疗效评价分别是:A组优良率93.5%（29/31）,B组优良率64.7%（11/17）,C组优良率92.8%（26/28）,经统计学处理（χ2检验）显示A组、C组与B组在术后疗效上比较有显著差异（P<0.05）,但A组与C组在术后疗效上比较无显著差异（P>0.05）。
结论:跟骨骨折在全身情况允许的前提下应尽早手术,最好在伤后8h内手术,可减少术后并发症,能取得满意的临床疗效。若全身情况欠佳伴有局部软组织肿胀和张力性水泡发生的患者,应在病情稳定,肿胀消退,张力性水泡好转和皱褶试验阴性时手术,以7~14d内手术为宜。 |
| 【关键词】跟骨 骨折 外科手术 |
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| Clinical study of surgical time selection in severe calcaneal fractures |
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ABSTRACT
Objective:To investigate the essentiality,superiority of the opportunity selection in operative treatment of calcaneal!fractures and the functional rehabilitation of subtalar joint or calcaneocuboid joint.
Methods:Seventy-six foot in 71cases(49 male and 22 female,the average age of 35.6 years ranging from 19 to 56 years)of calcaneal fractures(type of SandersⅡ,Ⅲ and Ⅳ)were treated with open reduction,autogenous bone graft and calcaneal plate internal fixation.According to the timing selection of operation,these cases were divided into 3 groups:operation within 8 hours after injury(group A),during 8 h to 7 d after injury(group B)and during 7 to 14 d after injury(group C).The curative effect of operation was then evaluated.
Results:Seventy-six foot in 71 cases were followed up for 6 months to 3.5 years(at an average of 19 months).No one suffered loosening or rupture of instrument,and union of fractures were occurred in all cases.The mean time of fracture healing was 8.5 weeks(range 8 to 12 weeks).Compared with preoperative X-ray,the height and width of calcaneus,Bhler′s angle and Gissane′s angle in postoperative X-ray films improved significantly(P<0.01).Postoperative complication rate was 9.7% in group A,41.2% in group B,and 10.7% in group C.Significant difference was observed between group A,C and group B(P<0.05).No statistical difference,however,was observed between group A and group C(P>0.05).With Kerr score,93.5% obtained good results in group A,64.8% in group B,and 92.8% in group C.Significant difference was observed between group A,C with group B(P<0.05),but no difference was observed between group A and group C(P>0.05).
Conclusion:Operation should be performed as early as possible with premise of good general condition.The best opportunity for operation is within 8 hours following injury.It may reduce the incidence of postoperative complications and gain good clinical outcome.Patient with bad general condition and region swollen soft tissue or tension blisters should delay the operation.It can be carried out when the patient′s condition becomes stabilization,swollen soft tissue subsides,tension blisters improves and the reductus test gets negative result.The period during 7 to 14 d after injury is much better for surgical treatment. |
| KEY WORDS Calcaneus Fractures Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张俊杰,田耜奇,张坚平,孔丽萍,杨顺华.严重跟骨骨折手术时机选择的临床研究[J].中国骨伤,2007,20(5):307~309 |
| 英文格式: | ZHANG Jun-jie,TIAN Si-qi,ZHANG Jian-ping,KONG Li-ping,YANG Shun-hua.Clinical study of surgical time selection in severe calcaneal fractures[J].zhongguo gu shang / China J Orthop Trauma ,2007,20(5):307~309 |
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