儿童跟骨关节内骨折非手术治疗与手术治疗疗效比较

目的 比较儿童跟骨关节内骨折非手术治疗与手术治疗的临床疗效.方法 从2000年4月至2007年11月,非手术治疗儿童跟骨关节内骨折17例18足,经跗骨窦入路复位内固定治疗12例13足.比较治疗前后Bhler角、Gissane角差异,功能评价采用Maryland评分系统.结果 非手术组平均随访时间36.2个月(14～73个月),手术组平均随访时间33.7个月(12～68个月),随访时骨折均获愈合.手术组的Bhler角和Gissane角治疗前后比较,差异有统计学意义(P＜0.01).按Maryland评分,非手术组评分93～100分,平均97.3分;而手术组评分88～100分,平均95.4分.两组功能评价比较,差异无统计学意义(P＞0.05).结论 儿童跟骨关节内骨折非手术治疗与手术治疗的临床疗效无明显差异,其治疗方式的选择应根据患其他儿的个体状况、骨折类型等综合考虑.

Comparison of nonoperative and operative treatment of intraarticular calcaneal fractures in children

Objective To compare the clinical outcomes of nonoperative and operative treatment of intraarticular calcaneal fractures in children.Methods Between April 2000 and November 2007, 18 intraarticular calcaneal fractures in 17 children were treated with nonoperative therapies, and 13 intraarticular calcaneal fractures in 12 children were treated with open reduction internal fixation using sinus tarsi approach. Pre-and postoperative B?hler angle and Gissane angle of all patients were measured on radiographs. Foot function were evaluated according to Maryland Foot Scoring Criterion.Results The average length of follow-up of the nonoperative group was 36.2 months (14-73 months), and 33.7 months (12-68 months) of the operative group. Al1 patients achieved complete fracture healing. After surgery, B?hler angle and Gissane angle were significantly restored (P＜0.01). The average Maryland score was 97.3 points in the nonoperative group (93-100 points) and 95.4 points in the operative group (88-100 points), no difference was found between these two groups (P＞0.05). Conclusions The clinical outcomes of nonoperative and operative treatment of intraarticular calcaneal fractures in children are similar. Therapeutic plan should be developed on patients' individual clinical conditions and fracture type.