跟骨关节内骨折保守治疗与手术治疗的病例对照研究

Case-control study on conservative and operative therapy in the treatment of intra-articular fracture of calcaneus

目的:探讨跟骨关节内骨折的损伤机制并比较保守与手术治疗效果。方法:自2006年至2008年对48例(52足)跟骨关节内骨折,分为2组:保守治疗组和手术治疗组。保守治疗组30例,男26例,女4例;年龄2～73岁,平均(49.2±8.5)岁;行手法复位、撬拨、外固定治疗,并进行早期功能锻炼。手术治疗组18例,男14例,女4例;年龄26～66岁,平均(50.1±19.3)岁;行切开复位内固定治疗。通过测定疗前与疗后跟骨高度、宽度、B觟hler角及Gissane角进行疗效评定,对保守与手术方法的疗效进行比较。结果:两组患者均获随访,时间8～18个月,平均12个月;术后负重时间3～6个月,平均4个月;平均12个月骨折全部愈合。治疗后2组跟骨高度、宽度、B觟hler角及Gissane角差异无统计学意义。治疗后按AOFAS踝与后足功能评分标准评估踝关节功能,保守治疗组优18例,良6例,可5例,差1例;手术治疗组优4例,良7例,可6例,差1例。2组疗效比较,保守治疗组疗效优于手术治疗组(P<0.05)。结论:切开复位钢板内固定直观,恢复跟骨解剖形态,保守治疗恢复解剖形态同时可进行早期功能恢复、早期愈合,同时避免了手术并发症。

Objective：To explore the traumatic mechanism and the effectiveness of conservative and operative therapy for intra-articular fracture of calcaneus.Methods：Forty-eight patients（52 feet） with intra-articular fractures were divided into two groups named as conservative group and operative group.There were 30 patients in the conservative group,including 26 males and 4 females,ranging in age from 2 to 73 years,with an average of（49.2±8.5）years.The patients in conservative group were treated with manual reduction,external fixation and functional exercise at early time.Among 18 patients in the operative group,14 patients were male and 4 patients were female,ranging in age from 26 to 66 years,with an average of（50.1±19.3）years.The patients in the operative group were treated with open reduction and internal fixation.The height and width of calcaneus,Bhler and Gissane angles were measured before and after treatment.The assessment in the function of ankle joints was scored according to AOFAS scoring system.Results：All the patients were followed up,and the duration ranged from 8 to 18 months,with a mean of 12 months.The time of weight-bearing ranged from 3 to 6 months,averaged 4 months.The fractures were fused completely on average of 12 months.The height and width of calcaneus,Bhler and Gissane angles had no statistically significance between two groups.According to AOFAS criteria,in the conservative group,18 patients reached an excellent result,6 good,5 poor and 1 bad;in operative group,4 patients reached an excellent result,7 good,6 poor and 1 bad.The therapeutic effect of conservative group was better than that of operative group.Conclusion：Operative therapy in intra-articular fracture of calcaneus with steel plate can directly perceive the restoration（or roughly restoration sometimes） of the anatomical shapes of calcaneus,while conservative therapy has advantages such as restoration of the anatomical shapes of calcaneus,early functional practice,early healing,and avoiding operational complications as well.