改良小切口复位植骨联合经皮克氏针内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床研究
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摘要
目的探讨改良小切口复位植骨联合经皮克氏针内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效及并发症。方法 2015年1月—2017年5月沧州中西医结合医院骨科收治Sanders Ⅱ、Ⅲ型跟骨骨折患者91例,按照随机数字表法,将患者分为切开复位钢板内固定治疗组45例(切开复位组)和改良小切口复位植骨联合经皮克氏针内固定治疗组46例(改良组)。切开复位组中男性25例,女性20例;年龄23～67岁,平均46. 0岁;骨折原因:高处坠落伤28例,道路交通伤17例。改良组中男性24例,女性22例;年龄23～68岁,平均46. 1岁;骨折原因:高处坠落伤29例,道路交通17例。分析统计治疗后的临床优良率,患者的住院情况,同时观察患者手术前后Bohler角、Gissane角、踝-后足评分(American orthopedic foot and ankle society,AOFAS),跟骨长度、宽度及高度,观察术后并发症发生情况。结果改良组患者临床优良率为93. 48%(43/46)明显高于切开复位组的62. 22%(28/45),两组比较差异有统计学意义(P <0. 05)。改良组患者出血量、伤口愈合时间及住院时间均明显低于切开复位组,分别为[(25. 17±7. 62) mL vs.(69. 25±10. 54) mL、(5. 42±1. 03) d vs.(10. 57±2. 69) d、(6. 04±1. 21) d vs.(12. 19±3. 68) d],而手术时间和费用均显著高于切开复位组,分别为[(95. 24±20. 58) min vs.(60. 12±15. 23) min、(1. 09±0. 03)万元vs.(0. 68±0. 04)万元],两组比较差异均有统计学意义(P <0. 05);与治疗前相比,两组患者治疗后Bohler角、Gissane角、AOFAS、跟骨长度及高度明显升高,而跟骨宽度显著下降,同时改良组患者治疗后临床指标的改善情况明显优于切开复位组,且差异均有统计学意义(P <0. 05);改良组患者术后并发症发生率为4. 35%,明显低于切开复位组的17. 78%(P <0. 05)。结论改良小切口复位植骨联合经皮克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效显著,能够改善患者的住院情况及临床相关指标,并且安全性高,值得在临床上推广应用。
Objective To explore the clinical curative effect and complications of modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation for the treatment of Sanders Ⅱ,Ⅲcalcaneal fractures. Methods According to the random number table method,91 patients with Sanders Ⅱ,Ⅲ calcaneal fractures from Jan. 2015 to May 2017 admitted in Cangzhou Integrative Medicine Hospital were treated by open reduction and plate internal fixation( 45 cases,open reduction group) and modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation( 46 cases,modified group). Open reduction group consisted of 25 cases of men and 20 cases of women with age of 23-67 years( average 46. 0 years). Fracture reasons included 28 cases of falling injury and 17 cases of road traffic injury. The modified group consisted of 24 cases of men and 22 cases of women aged 23-68 years( average 46. 1 years). Fracture reasons included 29 cases of high falling injury and 17 cases of road traffic accident. The clinical efficiency after treatment and the hospitalization of patients were analyzed. At the same time,the Bohler Angle,Gissane Angl,ankle-hind score( AOFAS),heel bone length,width and height were observed before and after surgery. In addition,the postoperative complications were observed. Results The clinical excellent and good rate of patients in the modified group was 93. 48%( 43/46),which was significantly higher than 62. 22%( 28/45) in the open reduction group,and the difference between the two groups was statistically significant( P < 0. 05). Compared with the open reduction group,the blood loss,wound healing time and hospital stay of the modified group were significantly lower(( 25. 17 ± 7. 62) mL vs.( 69. 25 ±10. 54) mL,( 5. 42 ± 1. 03) d vs.( 10. 57 ± 2. 69) d,( 6. 04 ± 1. 21) d vs.( 12. 19 ± 3. 68) d),and the operation time and cost were significantly higher than those of the open reduction group. The differences between the two groups were statistically significant( P < 0. 05). Compared with before treatment,the Bohler Angle,Gissane Angle,AOFAS,heel bone length and height of both groups after treatment increased significantly,while calcaneal width decreased significantly,at the same time,the improvement of clinical indicators of modified group after treatment was better than in the open reduction group,and the differences were statistically significant( P < 0. 05). The incidence of postoperative complications in the improved group was 4. 35%,which was significantly lower than the open reduction group of 17. 78%( P < 0. 05). Conclusion The clinical curative effect of modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation for the treatment of Sanders Ⅱ,Ⅲ calcaneal fractures is distinct. It can improve the patients' hospitalization and clinically relevant indexes and has high safety,which is worth popularization and application in clinic.
Objective To explore the clinical curative effect and complications of modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation for the treatment of Sanders Ⅱ,Ⅲcalcaneal fractures. Methods According to the random number table method,91 patients with Sanders Ⅱ,Ⅲ calcaneal fractures from Jan. 2015 to May 2017 admitted in Cangzhou Integrative Medicine Hospital were treated by open reduction and plate internal fixation( 45 cases,open reduction group) and modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation( 46 cases,modified group). Open reduction group consisted of 25 cases of men and 20 cases of women with age of 23-67 years( average 46. 0 years). Fracture reasons included 28 cases of falling injury and 17 cases of road traffic injury. The modified group consisted of 24 cases of men and 22 cases of women aged 23-68 years( average 46. 1 years). Fracture reasons included 29 cases of high falling injury and 17 cases of road traffic accident. The clinical efficiency after treatment and the hospitalization of patients were analyzed. At the same time,the Bohler Angle,Gissane Angl,ankle-hind score( AOFAS),heel bone length,width and height were observed before and after surgery. In addition,the postoperative complications were observed. Results The clinical excellent and good rate of patients in the modified group was 93. 48%( 43/46),which was significantly higher than 62. 22%( 28/45) in the open reduction group,and the difference between the two groups was statistically significant( P < 0. 05). Compared with the open reduction group,the blood loss,wound healing time and hospital stay of the modified group were significantly lower(( 25. 17 ± 7. 62) mL vs.( 69. 25 ±10. 54) mL,( 5. 42 ± 1. 03) d vs.( 10. 57 ± 2. 69) d,( 6. 04 ± 1. 21) d vs.( 12. 19 ± 3. 68) d),and the operation time and cost were significantly higher than those of the open reduction group. The differences between the two groups were statistically significant( P < 0. 05). Compared with before treatment,the Bohler Angle,Gissane Angle,AOFAS,heel bone length and height of both groups after treatment increased significantly,while calcaneal width decreased significantly,at the same time,the improvement of clinical indicators of modified group after treatment was better than in the open reduction group,and the differences were statistically significant( P < 0. 05). The incidence of postoperative complications in the improved group was 4. 35%,which was significantly lower than the open reduction group of 17. 78%( P < 0. 05). Conclusion The clinical curative effect of modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation for the treatment of Sanders Ⅱ,Ⅲ calcaneal fractures is distinct. It can improve the patients' hospitalization and clinically relevant indexes and has high safety,which is worth popularization and application in clinic.
引文
[1]戴锋,俞鹏飞,姜宏.跗骨窦小切口撬拨复位克氏针内固定治疗SandersⅢ型跟骨骨折[J].中国骨伤,2017,30(12):1080-1083.
[2]李建磊,钱宇,梁文清,等.闭合复位空心钉和解剖型跟骨钛板内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效比较[J].中国骨与关节损伤杂志,2014,29(12):1242-1244.
[3]马东弟,杨振建,宋锦旭,等.钢板与克氏针内固定修复跟骨骨折:Gissane角及Bohler角与跟骨高度比较[J].中国组织工程研究,2015,19(9):1423-1428.
[4]高峰,李翔,方永祥,等.普通解剖钢板加植骨与锁定钢板治疗SandersⅡ、Ⅲ型跟骨骨折的疗效比较[J].中华创伤骨科杂志,2015,17(9):791-795.
[5]谭新欢,毕宏政,聂伟志,等.SandersⅡ型跟骨骨折手法复位克氏针内固定术中植骨的临床研究[J].中医正骨,2015,27(6):6-11.
[6]Evran M,Sert M,Tetiker T,et al.Spontaneous calcaneal fracture in patients with diabetic foot ulcer:four cases report and review of literature[J].World J Clin Cases,2016,4(7):181-186.
[7]朱俊,王培,李文祥.2种手术方案治疗SandersⅡ型跟骨骨折的疗效比较[J/OL].安徽医学,2018,39(1):105-107
[8]王正义.足踝外科学[M].北京:人民军医出版社,2006:172-175.
[9]郭亚.切开复位克氏针内固定并植骨术治疗跟骨关节内骨折临床研究[J].中医学报,2013,28(1):41-42.
[10]冯志伟,李治国,刘世军,等.改良小切口复位植骨联合经皮克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J].中国骨与关节损伤杂志,2017,32(10):1101-1103.
[11]徐剑锋,谢学义,李金生,等.不同入路切口内固定治疗SandersⅢ型跟骨骨折的近远期疗效比较[J].四川医学,2017,38(2):174-177.
[12]梁志强,康建华,陈仲新,等.传统解剖钢板联合自体植骨与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折中治疗效果和安全性差异[J].中国医药科学,2017,7(4):34-37.
[13]施忠民,邹剑,顾文奇,等.经跗骨窦间隙与外侧“L”形切口治疗SandersⅡ型跟骨骨折的疗效比较[J].中华骨科杂志,2013,33(4):298-303.
[14]王新国,陈步俊,王俊,等.跗骨窦小切口辅以经皮撬拨复位克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中国骨与关节损伤杂志,2017,32(4):424-426.
[15]巩文庆,曹溢.微创撬拨复位空心拉力螺钉固定与钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的疗效分析[J].中国实用医药,2016,11(33):4-6.
[16]韩景全.经皮撬拨复位克氏针内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的临床疗效研究[J].中外医疗,2016,(12):188-190.
[17]胡科斌.手法配合外侧小切口复位植骨克氏针内固定治疗距下关节移位跟骨骨折的临床效果[J].浙江创伤外科,2017,22(5):864-865.
[2]李建磊,钱宇,梁文清,等.闭合复位空心钉和解剖型跟骨钛板内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效比较[J].中国骨与关节损伤杂志,2014,29(12):1242-1244.
[3]马东弟,杨振建,宋锦旭,等.钢板与克氏针内固定修复跟骨骨折:Gissane角及Bohler角与跟骨高度比较[J].中国组织工程研究,2015,19(9):1423-1428.
[4]高峰,李翔,方永祥,等.普通解剖钢板加植骨与锁定钢板治疗SandersⅡ、Ⅲ型跟骨骨折的疗效比较[J].中华创伤骨科杂志,2015,17(9):791-795.
[5]谭新欢,毕宏政,聂伟志,等.SandersⅡ型跟骨骨折手法复位克氏针内固定术中植骨的临床研究[J].中医正骨,2015,27(6):6-11.
[6]Evran M,Sert M,Tetiker T,et al.Spontaneous calcaneal fracture in patients with diabetic foot ulcer:four cases report and review of literature[J].World J Clin Cases,2016,4(7):181-186.
[7]朱俊,王培,李文祥.2种手术方案治疗SandersⅡ型跟骨骨折的疗效比较[J/OL].安徽医学,2018,39(1):105-107
[8]王正义.足踝外科学[M].北京:人民军医出版社,2006:172-175.
[9]郭亚.切开复位克氏针内固定并植骨术治疗跟骨关节内骨折临床研究[J].中医学报,2013,28(1):41-42.
[10]冯志伟,李治国,刘世军,等.改良小切口复位植骨联合经皮克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J].中国骨与关节损伤杂志,2017,32(10):1101-1103.
[11]徐剑锋,谢学义,李金生,等.不同入路切口内固定治疗SandersⅢ型跟骨骨折的近远期疗效比较[J].四川医学,2017,38(2):174-177.
[12]梁志强,康建华,陈仲新,等.传统解剖钢板联合自体植骨与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折中治疗效果和安全性差异[J].中国医药科学,2017,7(4):34-37.
[13]施忠民,邹剑,顾文奇,等.经跗骨窦间隙与外侧“L”形切口治疗SandersⅡ型跟骨骨折的疗效比较[J].中华骨科杂志,2013,33(4):298-303.
[14]王新国,陈步俊,王俊,等.跗骨窦小切口辅以经皮撬拨复位克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中国骨与关节损伤杂志,2017,32(4):424-426.
[15]巩文庆,曹溢.微创撬拨复位空心拉力螺钉固定与钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的疗效分析[J].中国实用医药,2016,11(33):4-6.
[16]韩景全.经皮撬拨复位克氏针内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的临床疗效研究[J].中外医疗,2016,(12):188-190.
[17]胡科斌.手法配合外侧小切口复位植骨克氏针内固定治疗距下关节移位跟骨骨折的临床效果[J].浙江创伤外科,2017,22(5):864-865.