26例跟骨接骨钢板治疗跟骨骨折疗效分析

目的:浅析跟骨接骨钢板治疗跟骨骨折的疗效。方法:对26例跟骨骨折(单侧)应用切开复位跟骨接骨钢板内固定治疗,进行回顾性分析,评价其临床疗效。结果:病例均随访,时间3～24个月,平均6个月,应用Maryland足部评分系统评价临床效果,优16例,良8例,可2例,优良率为92.3%。所有骨折均如期愈合,无皮瓣感染坏死,无钢板外露,2例切口渗出延迟愈合。结论:跟骨接骨钢板治疗跟骨骨折,临床疗效较满意。     

解剖型钛板内固定治疗跟骨关节内骨折临床分析

目的：探讨跟骨关节内骨折切开复位＋解剖型钛板内固定＋架桥式植骨的技巧与疗效。方法：采用解剖型钛板治疗48例共56足SandersⅡ～Ⅳ型跟骨骨折（其中Ⅱ型28足、Ⅲ型21足、Ⅳ型7足）,Borden位透视观察后关节面的恢复情况,并测量术前、术后的Bohler′s角、Gissane′s角、Peries′s角的变化。结果：随访时间为6～36个月,术后Bohler′s角、Gissane′s角、Peries′s角明显恢复,术前、术后比较差异有高度统计学意义（P〈0.01）,术后与健侧比较,差异无统计学意义（P〉0.05）。按Maryland足部评分系统,总优良率为83.9%（47/56）。结论：解剖型钛板内固定＋架桥式植骨治疗SandersⅡ～Ⅳ型跟骨骨折,固定可靠、并发症少、疗效满意,是治疗跟骨关节内骨折的有效方法。     

A comparison of union rates and complications between single screw and double screw fixation of sliding calcaneal osteotomy

Background

The number of screws used for sliding calcaneal osteotomy fixation has not been examined in the literature. The purpose of this paper is to examine this topic.

The cancellous structure in the calcaneus and its relation to mechanical stressing

Summary The structure of the cancellous bone in the calcaneus is comparable to a three-dimensional trajectorial system, best adapted to resisting bending stresses. This can be seen from the curve trend of the tensile fascicles. Since stressing takes place mainly in the sagittal plane, the adaptation of the structure must be examined in this plane.The photoelastic experiments prove that similar trajectorial patterns result from different types of loading (e.g., standing with and without muscular contraction, the transmission of forces before and after the fusion of the tuber apophysis); and therefore the stresses remain the same. The trajectorial patterns, already established from the experiments, correspond with those of the cancellous structure, which indicates that a state of adaptation exists. Using the definition given in Roux's maximum-minimum law, this means that the bone achieves maximum resistance with a minimum of material.The photoelastic experiments can also be successfully applied to a short, skeletal element, which has been stressed in a complex manner.Furthermore, the theory of causal histogenesis in the supporting tissues can be proved, since the position of the epiphyseal center coincides with that of a singular point (hydrostatic pressure) in the trajectorial pattern.A division of the trajectorial pattern, into lateral and medial fascicles (as described by T. von Lanz and W. Wachsmuth) cannot be seen in the bone sections and consequently cannot be regarded as being factual.

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Zusammenfassung Der Spongiosaverlauf im Calcaneus entspricht einem dreidimensionalen Trajektoriensystem und ist optimal an die Beanspruchung — in diesem Fall Biegung — angepaßt. Aus dieser Biegebeanspruchung resultiert ein gebogener Verlauf der Zugbündel.In der Sagittalebene liegt die Hauptbeanspruchung, so daß eine Anpassung der Struktur in dieser Ebene nachgeprüft werden muß.In spannungsoptischen Versuchen läßt sich nachweisen, daß bei verschiedenen Belastungen (z.B. Stand mit und ohne Muskeleinsatz, Kraftübertragung vor und nach Synostose der Tuberapophyse) gleichartige Trajektorienverläufe entstehen; damit bleibt also die Beanspruchung gleich. Die gefundenen Trajektorienbilder stimmen mit der Ausrichtung der Spongiosa überein, das heißt, es liegt ein Zustand des Angepaßtseins vor. Im Sinne des Maximum-Minimum Gesetzes von Roux bedeutet dies, daß der Knochen mit einem Minimum an Material ein Maximum an Widerstand leisten kann.Die Methode der Spannungsoptik läßt sich auch an einem kleinen Skelettelement erfolgreich anwenden, das in komplizierter Weise beansprucht wird.Die theorie der kausalen Histogenese der Stützgewebe wird durch die Übereinstimmung der Lage des Epiphysenkerns mit der Lage eines singulären Punktes (hydrostatischer Druck) in einem weiteren Fall bestätigt. Eine Aufteilung der Trajektorienverläufe in laterale und mediale Bündel-wie sie im Buch von T. v. Lanz und W. Wachsmuth vorgenommen wird — findet sich nicht in den Knochenschnitten und entspricht somit nicht der Wirklichkeit.

     

跟骨外侧延长L形切口并发症的危险因素分析

目的 :探讨跟骨外侧延长"L"形切口治疗闭合性跟骨骨折术后发生切口并发症的相关危险因素,明确降低切口并发症的有效干预手段。方法:回顾性分析2011年1月至2015年1月收治的285例(315足)行跟骨外侧延长"L"形切口治疗闭合性跟骨骨折患者的临床资料,对可能影响术后切口并发症的18个临床相关危险因素进行单因素分析,对存在统计差异的变量再给予多因素Logistic回归分析。结果:285例(315足)共有29例(30足)出现切口并发症,其中切口皮缘红肿渗出、不愈合9足,皮缘发黑坏死或者切口裂开16足,皮肤软组织浅层感染3足,骨髓炎2足。单因素分析结果显示:坠落高度(P=0.017)、糖尿病病史(P=0.026)、吸烟史(P=0.001)、手术时间(P=0.003)4个因素差异有统计学意义,将这些因素再进行多因素Logistic回归分析,发现糖尿病(P=0.029)、吸烟史(P0.001)、手术时间(P=0.018)是跟骨外侧延长"L"形切口术后并发症的危险因素。结论 :术前戒烟、积极控制血糖以及熟悉手术操作,有效减短手术时间可以减少跟骨外侧延长"L"形切口并发症的发生率。     

Evaluation and quantification of geographical differences in wound complication rates following the extended lateral approach in displaced intra-articular calcaneal fractures – A systematic review of the literature

IntroductionCalcaneal fracture surgery is often performed via the extended lateral approach (ELA). Large differences are reported in literature on wound complication rates. Aim was to perform a systematic review on reported postoperative wound complication (POWC) and postoperative wound infection (POWI) rates following the ELA and evaluate and quantify geographical differences.MethodsA literature search was conducted in the MEDLINE and EMBASE databases and Cochrane Library. Studies before 2000, with <10 patients, biomechanical studies and reviews were excluded. No restrictions regarding language were applied.Results3068 articles were identified of which 123 were included, with 8584 calcaneal fractures in 28 different countries. The average total number of POWC was 14.3%, with 3.8% of superficial and 2.2% of deep infections. The highest POWI rate was found in Europe (12.1%) and the lowest in North America (2.8%). A significant difference in incidence of deep POWI between continents was detected (median 0–3.8%). No differences were found in incidence of POWC and POWI between retro- and prospective studies (respectively p = 0.970, p = 0.748) or studies with <10 or ≥10 operations per year (respectively p = 0.326, p = 0.378). However, lower rates of POWI were found in studies with a follow up of >3 months (p = 0.01).ConclusionLarge differences were detected in incidence of POWC and POWI following calcaneal fracture surgery with the ELA between countries and continents. We did not find a lower POWC or POWI rate in retrospective studies compared to prospective studies, larger studies or in studies in which more patients were treated annually. However, the rate of POWI was significantly lower in studies with a follow up of >3 months. We advise the use of a reliable postoperative complication registration system and uniformity in the use of standardized definitions of wound complications for calcaneal fracture surgery.     

Calcaneal Ultrasound Attenuation in an Elderly Population: Measurement Position and Relationships with Body Size and Past Fractures

This study demonstrates the relationship between past fracture, body size and broadband ultrasound attenuation (BUA) and investigates two sites of BUA measurement in a representative elderly population of men and women (n= 2106). We measured BUA at a fixed position and at a consistent anatomic position within the calcaneus. We found fixed BUA was less closely correlated with stature and age than anatomic BUA. Both correlations were substantially weaker in men than in women. Mean BUA was significantly lower in women with a past fracture compared with nonfracturers (fixed BUA 63.3 vs 69.4 dB/MHz, p= 0.0004; anatomic BUA 77.6 vs 81.7 dB/MHz, p= 0.013). However, in women, the fixed BUA was better than the anatomic BUA at discriminating between fracturers and nonfracturers (OR 1.38/SD (95% CI 1.12–1.68) and OR 1.22/SD (0.99–1.52), respectively) when adjusted for body size and age. There was no significant difference in either BUA in men with or without a past fracture. In conclusion, currently the fixed position for BUA measurement is preferable and, whilst we have demonstrated that it is possible to locate an anatomically consistent point in the calcaneus, the position chosen by this study did not provide a measurement with more discriminatory capability than the fixed position. In women, BUA behaves similarly to bone mineral density in relation to stature and in its strength of association with past fracture, while the lack of association in men may reflect differing contributions by bone strength to fracture risk in the sexes. Received: 13 January 1999 / Accepted: 25 March 1999     

Trabecular Bone Architecture in the Distal Radius Using Magnetic Resonance Imaging in Subjects with Fractures of the Proximal Femur

To determine whether magnetic resonance (MR)-derived measures of trabecular bone architecture in the distal radius are predictive for prevalent hip fractures, 20 subjects with hip fractures and 19 age-matched postmenopausal controls were studied. Bone mineral density (BMD) measures at the hip (dual-energy X-ray absorptiometry, DXA) and the distal radius (peripheral quantitative computed tomography, pQCT) were also obtained. We compared the MR-based structural measures derived in the radius with those in the calcaneus of the same patients. In the radius, images were acquired at an in-plane resolution of 156 μm and a slice thickness of 0.5 mm. Stereologic measures such as the apparent trabecular thickness (app. Tb.Th), fractional trabecular bone volume (app. BV/TV), trabecular spacing (app. Tb.Sp) and trabecular number (app. Tb.N) were derived from the images. Measures of app. Tb.Sp and app. Tb.N in the distal radius showed significant (p<0.05) differences between the two groups, as did hip BMD measures. However, radial trabecular BMD measures showed only a marginal difference (p= 0.05). Receiver operating curve analysis was used to determine the diagnostic efficacy of BMD, structural measures and a combination of the two. The area under the curve (AUC) for total hip BMD was 0.73, and for radial trabecular BMD was 0.69. AUC for most of the measures of trabecular bone structure at the distal radius was lower than for hip BMD measures; however, AUC for app. Tb.N at the radius was 0.69, comparable to trabecular BMD using pQCT. The AUC for combined BMD (hip) and structure measures was higher (0.87) when radius and calcaneus structure was included. Measures of trabecular architecture derived from MR images combined with BMD measures improve the discrimination between subjects with hip fractures and normal age-matched controls. Received: 22 December 1998 / Accepted: 12 February 1999     

Comparison of the Curative Effect of Percutaneous Reduction with Plastic Calcaneal Forceps Combined with Medial External Fixation in the Treatment of Intra‐Articular Calcaneal Fractures

ObjectiveTo compare the clinical efficacy of percutaneous minimally invasive reduction combined with external fixation and a tarsal sinus approach to treat Sanders type II and III intra‐articular calcaneal fractures.MethodsThe clinical data of 64 patients with Sanders type II and III calcaneal fractures admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed; data includedage, sex, body mass index. According to the surgical method, they were divided into the percutaneous minimally invasive reduction with internal and external fixation group (30 cases) and the tarsal sinus approach group (34 cases).The two groups of patients were compared in terms of the time tosurgery, length of hospital stay, intraoperative blood loss, operative duration, complications, radiographic features, including the heel bone length, width, height, Bohlerangle, Gissane angle, and calcaneal varus angle, and clinical efficacy indicators, including the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) pain score, health survey profile (SF‐36) score and Maryland ankle function score.ResultsPatients in both groups were followed up for 12 to 50 months, with an average of 24.8 months.Bony union was achieved in all cases. The time to surgery, length of hospitalstay, intraoperative blood loss and incidence of incision‐related complications were significantly lower in the percutaneous minimally invasive medial external fixation group than in the tarsal sinus group (P < 0.01). At the last follow‐up, the calcaneal length, width, and height, Bohler angle, Gissane angle, and varus angle were significantly increased in both groups (P < 0.01), the calcaneal width was significantly lower after than before surgery (P < 0.01), and there were no statistically significant differences between the two groups (P > 0.05). As measures of clinical efficacy, the AOFAS, VAS, SF‐36 and Maryland scores were 85.28 ± 8.21, 0.84 ± 1.21, 82.95 ± 3.25 and 83.56 ± 3.32, respectively, at the last follow‐up in the percutaneous minimally invasive medial external fixation group and 83.32 ± 7.69, 1.85 ± 1.32, 80.71 ± 5.42, and 81.85 ± 2.41 in the tarsal sinus group, respectively, with no significant differences between the two groups (P > 0.05).ConclusionUnder the condition of a good command of surgical indications and surgical skills, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with medial external fixation for the treatment of Sanders type II and III intra‐articular calcaneal fractures can achieve similar clinical effects as the tarsal sinus approach. However, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages, such as fewer complications, less bloodloss, and a shorter operation, and thus has good safety and is worthy of clinical promotion.