跟骨移位性关节内骨折内固定手术疗效及影响因素

目的探讨跟骨移位性关节内骨折（DIACF）切开复位内固定手术疗效及影响手术疗效的相关因素。方法选取2013年2月至2015年11月跟骨移位性关节内骨折患者46例（57足），用PACS图文分析系统测量手术前后的关节面移位距离、Gissane角、Bohler角、跟骨长宽高并进行统计学分析，并对可能影响手术疗效的因素进行分组统计，手术疗效按Maryland标准评定。结果除跟骨长度外，其余各指标在手术前、后差异均有统计学意义（P〈0．05）。单因素分析发现Sanders分型、术后关节面移位距离、受伤至手术时间、术后Gissane、术后Bohler角组间差异有统计学意义（P〈0．05）；多因素Logistic回归分析发现术后Bohler角和Sanders分型为影响手术疗效的独立危险因素。结论切开复位内固定治疗DIACF可以取得满意疗效。术后Bohler角和Sanders分型是影响手术疗效的独立危险因素。临床中应避免不利因素，提高手术疗效。

Objective To investigate the operative effects and the factors influencing the effects of open reduction and internal fixation of displaced intra-articular calcaneal fracture. Methods From February 2013 to November 2015, 46 patients with displaced intra-articular calcaneal fracture involved in 57 feet were treated by open reduction and intemal fixation.We used PACS system to measure and analyze statistically the calcaneal articular surface step, the Gissane angle, the Bohler angle and calcaneal length, width and height before and after operation. Patients were then grouped according to the possible factors related to the operative results. Clinical results were evaluated and compared within each group.The function and curative effects were assessed according to the Maryland score. Results There were significant differences between preoperative and postoperative data except for calcaneal length. Univariate analysis showed that Sanders type, quality of fracture reduction, time to surgery after injury, postoperative Gissane angle, postoperative Bohler angle differed significantly within groups （ P〈0.05 ） . After Logistic regression analysis, we realized that Bohler angle and the Sanders type are independent risk factors of operative effects. Conclusion It is satisfactory to treat calcaneal displaced intra-articular fractures by open reduction and intemal fixation. Postoperative Bohler angle and the Sanders type are independent risk factors of operative effects. The unfavorable influences should be avoided to improve the operative results.