跟骨关节内移位骨折治疗的CT引导与效果评价

CT-guided treatment and evaluation for intra-articular calcaneal fractures

目的评价跟骨关节内移位骨折治疗的CT引导与效果。方法 90例跟骨关节内移位骨折患者(CT分型:ⅠA 10例,ⅠB型12例,ⅠC型14例,ⅠD型4例;ⅡA 8例,ⅡB型12例,ⅡC型13例,ⅡD型7例)根据治疗方法的不同分为治疗组与对照组各45例,对照组采用撬拨复位手术,治疗组采用经皮螺钉内固定手术。结果治疗组的预后优良率为77.8%,而对照组的优良率为55.6%,组间比较差异有统计学意义(P<0.05)。CT分型为Ⅰ型患者的预后优良率明显高于Ⅱ型患者,对比差异也有统计学意义(P<0.01)。2组手术前的Gissane角和Bohler角对比无明显差异,治疗后都明显上升(P<0.01),同时组间比较差异有统计学意义(P<0.01)。结论 CT能直接清楚地显示跟骨骨折情况,对骨折分型与手术方法的选择有重要的指导作用,从而提高治疗效果,值得推广应用。

[ Objective] To evaluate the effects of CT-guided treatment for intra-articular calcaneal fractures. [ Methods] A total of 90 cases of intra-articular calcaneal fractures （CT classification： I A 10 case, I B 12 cases, I C 14 cases, I D 4 cases; Ⅱ A 8 cases, Ⅱ B 12 cases, Ⅱ C 13 cases, Ⅱ D 7 cases） were equally divided into treatment group {45 cases） and control group （45 cases ） according to the treatment methods, the control group were given poking reduction surgery, the treatment group received pereutaneous screw fixation. [ Results]The excellent prognosis of the treatment group was 77.8% , that was 55.6% in the control group, with significant difference between groups （ P 〈 0.05 ）. The CT classification of type I had better prognosis than that in the type Ⅱ（ P 〈 0.01 ）. The Bohler and Gissane angle in the 2 groups before surgery were not significantly different, while they were significantly increased after treatment （ P 〈 0.01 }, with significant difference between the groups （ P 〈 0.01 ）. [ Conclusion] CT can clearly and directly show the fractures situation, and it plays important role in guiding fracture type and choice of surgical meth- ods, so as to enhance the therapeutic effect, and it is worthy of wide application.