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find Keyword "跟骨骨折" 38 results
  • NON-OPERATION RELATED RISK FACTORS OF WOUND COMPLICATIONS OF CALCANEAL FRACTURES USING LATERAL EXTENSIVE L-SHAPED INCISION

    Objective To analyze the non-operation related risk factors of the wound complications by using lateral extensive L-shaped incision for open reduction and internal fixation of calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 58 patients with closed calcaneal fractures (63 calcaneus) treated by using lateral intensive L-shaped incision for open reduction and internal fixation between September 2006 and August 2011. There were 52 males (56 calcaneus) and 6 females (7 calcaneus), aged 18 to 64 years (mean, 35 years). The causes of injury included fall injury in 53 cases (58 calcaneus), traffic injury in 5 cases (5 calcaneus). The mean time between injury and operation was 8 days (range, 3-22 days). According to Sanders classification, 4 calcaneus were rated as type II, 31 calcaneus as type III, and 28 calcaneus as type IV. Postoperative complications were observed and graded; 58 patients were divided into complication group (≥grade 2) and control group (lt; grade 2). The univariate analysis was used to analyze 18 factors which may lead to wound complications; multi-factor unconditioned logistic regression analysis was done for the factors showing significant difference. Results According to postoperative wound complications grading, 41 patients (46 calcaneus) were included in the control group, whose incision healed primarily, and 17 patients (17 calcaneus) in the complication group. In 17 patients of the complication group, 14 had skin necrosis or dehiscence, and 3 had superficial infection; they obtained healing after symptomatic treatment. The univariate analysis showed significant differences in combined spinal fracture, diabetes mellitus, and long-term smoking between 2 groups (P lt; 0.05). The logistic regression analysis revealed that combined spinal fracture was an independent risk factor for wound complications (95% confidence interval: 0.004-0.360, P=0.004). Conclusion Combined spinal fracture is an independent risk factor for wound complications after open reduction and internal fixation of calcaneal fracture using lateral extensive L-shaped incision.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • SURGICAL TREATMENT OF CALCANEAL FRACTURE INVOLVING TALOCALCANEAL AND CALCANEOCUBOID JOINTS

    Objective To explore the method and effectiveness of lateral calcaneal U-shaped incision approach to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints. Methods Between January 2009 and March 2011, 36 cases of calcaneal fractures involving the talocalcaneal and calcaneocuboid joints were treated by the lateral calcaneal U-shaped incision approach and calcaneal anatomical plate fixation. There were 27 males and 9 females with an average age of 38.7 years (range, 19-58 years). According to the Sanders classification criteria, there were 12 cases of type II, 20 cases of type III, and 4 cases of type IV. The Bouml;hler and Gissane angles were (6.21 ± 10.48)° and (89.85 ± 12.34)°, respectively. The average time from injury to surgery was 4.2 days (range, 2-14 days). Results Superficial skin flap necrosis and wound exudate occurred in 1 case respectively, which were cured after dressing change; primary healing was obtained in the other cases. All the cases were followed up 12-26 months (mean, 15.2 months). The X-ray films showed that all fractures healed with an average healing time of 10.6 weeks (range, 8-12 weeks). The reduction of articular surface was satisfactory, and the heel height returned to normal. No complication of breakage of internal fixation or traumatic arthritis occurred. The Bouml;hler and Gissane angles were (29.64 ± 5.33)° and (121.75 ± 6.65)°, respectively at 3 months after operation, showing significant differences when compared with the preoperative values (t=43.800, P=0.000; t=33.200, P=0.000). The average time of plate removal was 11.2 months (range, 9-20 months). According to Maryland foot score, the results were excellent in 17 cases, good in 15 cases, and fair in 4 cases; the excellent and good rate was 88.9%. Conclusion The lateral calcaneal U-shaped incision approach is an effective method to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints, which can expose the fracture fully, restore the anatomy of the calcaneal bone, and do early exercise under the condition of rigid internal fixation.

    Release date:2016-08-31 04:06 Export PDF Favorites Scan
  • APPLICATION PROGRESS OF MINIMALLY INVASIVE TECHNIQUE IN TREATMENT OF CALCANEUS FRACTURES

    Objective To review the application progress of minimally invasive technique in the treatment of calcaneus fractures and to analyze the advantages and disadvantages of each method as well as to predict the trend of development in the field. Methods Domestic and abroad literature concerning the minimally invasive technique applied in calcaneus fractures in recent years was reviewed extensively and analyzed thoroughly. Results There are both advantages and limitations of each minimally invasive technique including percutaneous reduction and fixation, limited incision, external fixator, arthroscopic assisted reduction, and balloon expansion reduction. But every technique is developing rapidly and becoming more and more effective. Conclusion A variety of minimally invasive technique can not only be used independently but also can be applied jointly to complement one another. It needs further study how to improve the effectiveness and expand the indications. And the theoretical basis of evidence-based medicine needs to be provided more.

    Release date:2016-08-31 04:06 Export PDF Favorites Scan
  • CONSERVATIVE DRESSING CHANGE METHOD IN TREATMENT OF SKIN NECROSIS AFTER OPEN REDUCTION WITH INTERNAL FIXATION OF CALCANEAL FRACTURE

    Objective To explore the effectiveness of conservative dressing change method in treating skin necrosis after open reduction with internal fixation (ORIF) of calcaneal fracture. Methods Between November 2007 and June 2010, 21 cases of skin necrosis after ORIF of calcaneal fracture were treated, including 18 cases of Sanders type II and 3 cases ofSanders type III. There were 20 males and 1 female with an average age of 33.1 years (range, 23-60 years). All fractures were close fractures and were treated by ORIF with plate. Skin necrosis occurred at 3-5 days (mean, 4 days) after internal fixation. The interval of internal fixation and conservative dressing change was 3-10 days (mean, 6 days). Of 21 cases, 10 cases had superfacial skin necrosis with a size range of 1-10 cm in length and 0.5-1.5 cm in width, and 11 cases had deep skin necrosis with a size range of 1-8 cm in length and 0.5-1.5 cm in width. The conservative dressing change method was performed. Alcohol (75%) was used at the edge of the zone of skin necrosis, whereas sal ine in the central of the wound every 2-3 days. The necrosed tissue in the wound was reserved as more as possible. No patient was given antibiotic. Results Scab formed and subcrust heal ing was observed after 6-30 days (mean, 16 days) in 20 patients, 1 patient failed for discontinue treatment. No case had deep infection or osteomyl itis. The mean treatment time was 7.8 days (range, 6-14 days) in 10 cases of superfacial skin necrosis, and was 23.1 days (range, 14-30 days) in 10 cases of deep skin necrosis. All cases were followed up 92 days on average (range, 54-123 days). The scar was usually dark red and hard, protruding from the normal skin. No patient had difficulty in weight bearing or walking. Conclusion Skin necrosis after ORIF of calcaneal fracture can be cured by the conservative dressing change method, and this conservative method is effective and economic.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • 经皮撬拨复位加自固化磷酸钙人工骨植入治疗跟骨骨折

    目的 总结经皮撬拨复位结合自固化磷酸钙人工骨植入治疗跟骨骨折的治疗方法和效果。 方 法 2004 年6 月- 2008 年6 月,收治跟骨骨折13 例。男11 例,女2 例;年龄18 ~ 61 岁,平均38 岁。高处坠落伤9 例,砸伤4 例。均为单侧闭合骨折。按Sanders 分型:Ⅱ型5 例,Ⅲ型7 例,Ⅳ型1 例。X线片示Bouml;hler 角为— 10 ~ 15°,平均5°。受伤至手术时间4 h ~ 2 d。行经皮克氏针撬拨复位骨折,于骨折缺损处注入4 ~ 6 mL 注射型自固化磷酸钙人工骨修复。 结果 术后无软组织坏死及感染发生。13 例均获随访,随访时间1 ~ 2 年。X 线片示骨折均于术后3 ~ 5 个月愈合;Bouml;hler 角为15 ~ 40°,平均27.8°。关节面复位高度无丢失,骨折愈合后逐渐恢复负重行走功能。注射型材料未引起血磷、血钙增高及过敏、毒性反应。11 例于术后6 个月自固化磷酸钙人工骨完全降解,2 例于8 个月降解完全;降解同时骨组织生成。按美国足踝外科学会(AOFAS)评分:优7 例,良4 例,一般2 例,优良率84.6%。 结论 经皮撬拨复位加自固化磷酸钙人工骨植入治疗跟骨骨折具有操作简便、创伤小、并发症少的优点。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • 涉及跟距关节的跟骨骨折手术治疗

    目的 总结跟骨钢板内固定治疗涉及跟距关节的跟骨闭合性骨折的临床疗效。 方法 2004 年4 月- 2008 年6 月,采用经足跟部外侧延长的L 形切口显露跟骨,切开复位跟骨钢板内固定治疗高处坠落伤所致涉及跟距关节的跟骨骨折18 例。其中男12 例,女6 例;年龄26 ~ 57 岁,平均37 岁。左侧7 例,右侧11 例。骨折按Sanders 分型:Ⅱ型12 例,Ⅲ型5 例,Ⅳ型1 例。术前常规行跟骨侧位、轴位X线片及CT 检查,骨折均累及距下关节并伴有不同程度移位,Gissane 角及Bouml;hler 角明显减小。受伤至手术时间5 ~ 7 d。 结果 术后3 d 1 例伤口感染,术后5 d 1 例创缘部分缺血坏死,经对症治疗后伤口愈合;余患者切口均Ⅰ期愈合。18 例均获随访,随访时间8 ~ 12 个月,平均10 个月。X 线片示所有患者骨折均达骨性愈合,愈合时间2 ~ 4 个月,平均3 个月。末次随访时Gissane 角及Bouml;hler 角均较术前明显改善。术后8 个月,按Maryland 足部评分标准,获优5 例,良10 例,差3 例,优良率83.3%。 结论 切开复位跟骨钢板内固定是治疗涉及跟距关节的跟骨骨折的一种有效方法。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • ARTHROSCOPICAL SUBTALAR ARTHRODESIS FOR MALUNION OF CALCANEAL FRACTURES

    Objective To evaluate the cl inical results of arthroscopical subtalar arthrodesis for malunion of calcaneal fractures. Methods Between July 2006 and December 2008, 12 cases of malunion of calcaneal fractures were treated witharthroscopical subtalar arthrodesis, inculding 10 males and 2 females with an age range of 38-54 years (44.8 years on average). The location was left side in 5 cases and right side in 7 cases. The injury was caused by fall ing from height in 8 cases, by traffic accident in 3 cases, and other in 1 case. It was 3-7 months from injury to operation. All cases were classified as Stephens type II. The total score was 35.68 ± 10.35 and the pain score was 8.14 ± 1.83 before operation according to Hindfoot scores system of American Orthopaedic Foot amp; Ankle Society (AOFAS). Results All incisions achieved parimary heal ing and the patients were all followed up 14-32 months (18 months on average). The X-ray films showed bony fusion after 10-14 weeks (11.5 weeks on average). The total score was 76.45 ± 9.83 and the pain score was 1.52 ± 1.48 after operation according to Hindfoot scores system of AOFAS, showing significant difference when compared with those before operation (P lt; 0.01). Conclusion Arthroscopical subtalar arthrodesis can get satisfactory fusion rate with few compl ications for malunion of calcaneal fractures.

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
  • 腓肠神经营养血管皮瓣修复跟骨骨折术后软组织缺损

    目的 总结采用腓肠神经营养血管皮瓣修复跟骨骨折内固定术后皮肤缺损伴骨、钢板外露的方法及疗效。 方法 2002 年3 月- 2007 年1 月,应用远端蒂腓肠神经营养血管皮瓣修复8 例男性跟骨骨折内固定术后皮肤软组织缺损伴骨、钢板外露。年龄30 ~ 56 岁。术前7 例细菌培养阳性,1 例阴性。创面范围为3 cm × 1 cm ~ 5 cm × 3 cm。该次手术至上次手术时间为20 d ~ 6 个月。术中皮瓣切取范围4 cm × 2 cm ~ 6 cm × 4 cm。供区均直接拉拢缝合。 结 果 术后皮瓣均完全成活,创面均Ⅰ期愈合。供区切口均Ⅰ期愈合。患者术后均获随访,随访时间3 ~ 7 年。术后3 ~ 6 个月骨折均愈合,1 年后取出内固定。皮瓣外形、质地良好,负重行走正常,无窦道、溃疡等并发症发生。 结论 腓肠神经营养血管皮瓣修复跟骨骨折内固定术后皮肤缺损伴骨、钢板外露,操作简便,疗效可靠。

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
  • TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURE BY BONE GRAFTING AND PLASTIC TI-ALLOY PLATE INTERNAL FIXATION

    To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
  • 小切口加撬拨复位治疗跟骨骨折

    总结小切口加撬拨复位内固定治疗跟骨骨折的临床疗效。 方法 2005 年6 月- 2007 年7 月收治跟骨骨折23 例25 足。男20 例,女3 例;年龄23 ~ 55 岁,平均40.5 岁。按Sanders 分型:Ⅱ型7 足,Ⅲ型17 足,Ⅳ型1 足。受伤至手术时间7 ~ 14 d,平均10 d。采用外侧横行小切口加撬拨复位,并行自体髂骨植骨(2 ~ 4 g),松质骨螺钉内固定。 结果 术后伤口均Ⅰ期愈合,无皮肤坏死和螺钉断裂发生。23 例均获随访,随访时间6 ~ 36 个月,平均15个月。术后Bouml;lher 角及Gissane 均较术前明显改善(P lt; 0.05)。患者负重行走6 个月,跟骨高度无明显丢失。根据美国足踝外科学会足部功能评分系统评定,优17 足,良6 足,可2 足,优良率92℅。 结论 小切口加撬拨复位内固定是一种治疗跟骨关节内骨折的有效方法。

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
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