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고령 환자의 전위성 관절 내 종골 골절의 수술적 치료 - 최소 침습 접근법과 광범의 외측 접근법의 비교 -

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

대한골절학회지 2019년 32권 3호 p.135 ~ 142
박홍기, 고재윤, 이승관, 백종민,
소속 상세정보
박홍기 ( Park Hong-Gi ) - 가천대학교 길병원 정형외과
고재윤 ( Ko Jae-Yoon ) - 가천대학교 길병원 정형외과
이승관 ( Lee Seung-Kwan ) - 가천대학교 길병원 정형외과
백종민 ( Baik Jong-Min ) - 가천대학교 길병원 정형외과

Abstract


Purpose: As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.

Materials and Methods: Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.

Results: No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.

Conclusion : The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

키워드

Calcaneus; Displaced intraarticular calcaneal fracture; Extensile lateral approach; Minimally invasive approach

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