The Study Of The Correlation Between The Prognosis Of Intra-articular Calcaneal Fractures And The Influential Factors

Object iveThe purpose of this study is to investigate the correlation between the curative effect and the influential factors of calcaneus fracture included subtalar joint surface, calcaneal hight, calcaneal width, outward and inward angle, Bohler angle and Gissane angle, and to analyse which are the primary and secondary factors to influence the curative effect among them. Then we can make sure the restoration standard and the primary and secondary factors when we treat calcaneal fractures.It can supervise clinic treatment. At the sametime, we can analyse the prognosis of the calceneal fractures in use of the specific correlation we have got,predict the curative effect based the calcaneal parameter after treatment, intervene in the case which would get a poor curative effect and causes serious complicates, ultimately improve curative effect. Then we investigate the correlation between the Chinese medicine and curative effect, pain decrease after calcaneus fracture, and search theory basis for traditional Chinese medicine to improve curative effect of calcaneal fractures.MethodsFrom Sep.2008 to Apr.2011,55cases (60 calcaneals) of intra-articular calcaneal fractures were collected from the Third affiliated hospital of Guangzhou University of TCM.It consisted of 43 male(48 calcaneals)and 12 female(12 calcaneals). There 37 cases were left and 23 cases were right. The average age was 43, range from 19 to 60. We measured the distance of articular surface collapsing, calcaneal hight, calcaneal width, outward and inward angle, Bohler angle and Gissane angle in lateral radiograph and axial radiograph of calcaneus after admission. We treated them with surgical treatment or non surgical treatment basised on the complexion of the fracture, combined with traditional Chinese medicine and fumigant.We measured them again after treatment and one month later. These cases were followed up range from 6 months to 9 months after treatment. The effect of treatment was evaluated according to the AOFAS Ankle Hindfoot scale and VAS.At last, we stored the data and the score which accord with the standard in computer, and use SPSS13.0 to process the data.Results1.All 60 calcaneals were followed up with an average time of 7 months (range from 6 to 9 months).40 calcaneals were treated with surgical treatment and 20 calcaneals were treated with non surgical treatment.39 calcaneals were combined with traditional Chinese medicine and fumigant,and 21 calcaneals didn't. The average score of AOFAS Ankle Hindfoot scale was 81.55. The results were excellent in 10, good in 39, fair in 11, and poor in 0. The total satisfactory rate was 80.1%.The average score of VAS was 2.03.The results were excellent in 39, good in 21, fair in O,and poor in O.The total satisfactory rate was 100%.2. Among these six factors we chosed,the followed factors are statistically significant to the AOFAS Ankle Hindfoot recovery score:t the distance of articular surface collapsing before treatment, the distance of articular surface collapsing,Bohler angle and Gissane angle after treatment, the distance of articular surface collapsing and Bohler angle one month after treatment. the distance of articular surface collapsing influence the score most among the six. The score were correlated negatively with the distance of articular surface collapsing, positively with Bohler angle and Gissane angle. 3. There were no difference between the Traditional Chinese medicine group and non-medicine group in age, side, gender and Sanders type(P>0.05). The AOFAS Ankle Hindfoot score and VAS score were no significant difference between the two groups in that condition(P>0.05).Conclusions1. Among all six factors which influence prognosis of intra-articular calcaneal fractures,the distance of articular surface collapsing and Bohler angle influence the score most. The distance of articular surface collapsing and Bohler angle can be used as indicators of the prognosis of intra-articular calcaneal fractures. Gissane angle is not determinate.It needs validated.2. Traditional Chinese medicine and fumigant can't significantly influence the AOFAS standard score and VAS score in the treatment of intra-articular calcaneal fractures. More study may be done in the less time of the swelling disappeared and less complications of surgical wound.