跟骨外侧U形切口的设计及临床应用
|
摘要
目的设计跟骨外侧U形切口并观察其治疗跟骨骨折的临床疗效。方法回顾性分析唐山市第二医院足踝外科自2010年1月至2016年10月采用跟骨外侧U形切口治疗的155例(167足)患者的临床资料,观察患者伤口愈合情况及术后疗效。结果 155例(167足)均获随访,随访时间12～48个月,平均28. 7个月。切口愈合良好,无伤口深部感染、皮肤坏死、钢板外露、骨折不愈合、延迟愈合等并发症发生,有6足发生皮肤浅表感染,经伤口换药后愈合。平均AOFAS评分(88. 32±7. 31)分,优良率达91. 0%,其中82足优,70足良,14足可,1足差,总体疗效满意。结论采用跟骨外侧U形切口复位固定跟骨骨折具有暴露充分,伤口并发症少,足部功能恢复好等特点,值得临床推广。
objective To observe the clinical efficacy of lateral calcaneal U-shaped incision in treatment of calcaneal fractures. Methods The clinical data of 155 patients(167 feet) of calcaneal fractures who treated with lateral calcaneal U-shaped incision in foot and ankle surgery department of second hospital of Tangshan from January 2010 to October 2016 were retrospectively analyzed. The clinical efficacy and incisions were observed. Results All cases were followed up for ranged from 12 to 48 months,with an average of 28. 7 months. All incisions and fracture were healing without complications such as deep infection,skin necrosis,plate exposure,non unions,or delayed union. There were 6 feets with superficial infections,which were cured by wound dressing. The mean AOFAS score was(88. 32 ± 7. 31),82 feet were rated excellent,70 good,14 fair and 1 poor,with excellent-to-good rate of 91. 0%. Conclusion The lateral calcaneal U-shaped incision is an effective method to treat calcaneal fractures with wound exposed fully,less complication and good functional recovery in foot,which is worthy of popularizing.
objective To observe the clinical efficacy of lateral calcaneal U-shaped incision in treatment of calcaneal fractures. Methods The clinical data of 155 patients(167 feet) of calcaneal fractures who treated with lateral calcaneal U-shaped incision in foot and ankle surgery department of second hospital of Tangshan from January 2010 to October 2016 were retrospectively analyzed. The clinical efficacy and incisions were observed. Results All cases were followed up for ranged from 12 to 48 months,with an average of 28. 7 months. All incisions and fracture were healing without complications such as deep infection,skin necrosis,plate exposure,non unions,or delayed union. There were 6 feets with superficial infections,which were cured by wound dressing. The mean AOFAS score was(88. 32 ± 7. 31),82 feet were rated excellent,70 good,14 fair and 1 poor,with excellent-to-good rate of 91. 0%. Conclusion The lateral calcaneal U-shaped incision is an effective method to treat calcaneal fractures with wound exposed fully,less complication and good functional recovery in foot,which is worthy of popularizing.
引文
[1]Molloy AP,Lipscombe SJ. Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions[J]. Foot Ankle Clin,2011,16(1):165-179. doi:10. 1016/j. fcl. 2010. 12. 008.
[2]何国祥,潘月来,谢勤,等.跟骨骨折的CT检查及其价值[J].中华放射学杂志,1994,28(8):544.
[3]Talarico LM,Vito GR,Zyryanov SY. Management of displaced intraarticular calcaneal fractures by using external ring fixation,minimally invasive open reduction,and early weightbearing[J]. J Foot Ankle Surg,2004,43(1):43-50. doi:10. 1053/j. jfas. 2003. 11. 010.
[4]Erduran M,Akseki D,Ulusal AE. A complication due to shock wave therapy resembling calcaneal stress fracture[J]. Foot Ankle Int,2013,34(4):599-602. doi:10. 1177/1071100712470917.
[5]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. doi:10. 3969/j. issn. 2095-4344. 2015. 09. 019.
[6]冯云华,谭广毅,文明,等.跟骨骨折术后皮肤坏死创面的修复[J].中国矫形外科杂志,2011,19(10):872-874. doi:10. 3977/j.issn. 1005-8478. 2011. 10. 26.
[7]沙宇,朱军方,杨树东,等.跟骨关节内骨折手术治疗并发症原因分析及防治[J].中国骨与关节损伤杂志,2006,21(2):153-154.doi:10. 3969/j. issn. 1672-9935. 2006. 02. 043.
[8]俞光荣,燕晓宇.跟骨骨折治疗方法的选择[J].中华骨科杂志,2006,26(2):134-141. doi:10. 3760/j. issn:0253-2352. 2006. 02. 019.
[9]王军,王玉兰,焦磊,等.跟骨关节内骨折手术治疗临床分析[J].局解手术学杂志,2011,20(5):538-539. doi:10. 3969/j.issn. 1672-5042. 2011. 05. 033.
[10]梁宏伟,余磊,赵斌,等.经皮撬拨内固定与切开复位内固定治疗跟骨骨折的比较[J].黑龙江医药,2016,29(5):986-988. doi:10. 1403/j. cnki. hljyy. 2016. 05. 091.
[11]Pang QJ,Yu X,Guo ZH. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture:A finite element analysis[J]. Pak J Med Sci,2014,30(5):1099-1103. doi:10. 12669/pjms. 305. 5301.
[12]Palmersheim K,Hines B,Olsen BL. Calcaneal fractures:update on current treatments[J]. Clin Podiatr Med Surg,2012,29(2):205-220. doi:10. 1016/j. cpm. 2012. 01. 007.
[13]Court-Brown CM,Schmied M,Schutte BG. Factors affecting infection after calcaneal fracture fixation[J]. Injury,2009,40(12):1313-1315. doi:10. 1016/j. injury. 2009. 03. 044.
[14]Bergin PF,Psaradellis T,Krosin MT,et al. Inpatient soft tissue protocol and wound complications in calcaneus fractures[J]. Foot Ankle Int,2012,33(6):492-497. doi:1016/j. injury. 2009. 03. 044.
[15]沙良宽,田家祥,李敬祥,等.撬拨复位与切开复位内固定治疗SandersⅡ型跟骨骨折的比较[J].中国修复重建外科杂志,2015,29(5):558-562. doi:10. 7507/1002-1892. 20150121.
[16]黄世超,倪锋,魏广奇,等.经皮撬拨复位空心螺钉与切开复位钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效比较[J].中国临床研究,2017,30(6):813-815. doi:10. 13429/j. cnki. cjcr. 2017. 06. 027.
[17]刘亮,周恩瑜,陈宇.经皮撬拨复位空心螺钉内固定SandersⅡ、Ⅲ型跟骨骨折[J].局解手术学杂志,2018,27(8):581-585.doi:10. 11659/jjssx. 01E018051.
[18]方志强.外踝下小切口结合微型锁定钢板治疗跟骨骨折体会[J].中国矫形外科杂志,2015,23(18):1722-1724. doi:10. 3977/j.issn. 1005-8478. 2015. 18. 21.
[19]缪逸鸣,王强,沈影超,等.“八”字双切口钢板内固定治疗跟骨骨折的临床疗效分析[J].中国临床医学,2018,25(1):95-99.doi:10. 12025/j. issn. 1008-6358. 2018. 20170408.
[20]吴旻昊.经微创跗骨窦切口入路与传统外侧L形切口入路比较治疗跟骨骨折的Meta分析[J].中国骨伤,2017,30(12):1118-1126. doi:10. 3969/j. issn. 1003-0034. 2017. 12. 009.
[21]陈永岗,肖勋刚,危小东,等.跟骨骨折患者的微创经皮钢板固定技术治疗[J].中国骨与关节杂志,2017,6(11):833-836. doi:10.3969/j. issn. 2095-252X. 2017. 11. 008.
[22]马骏,何斌,姜曙祥,等.“八”字微创入路内固定治疗跟骨骨折疗效观察[J].局解手术学杂志,2017,26(4):256-259. doi:10.11659/jjssx. 09E016065.
[23]陈滔,王子明.减少跟骨骨折术后皮缘坏死和疼痛的手术技巧[J].中华创伤杂志,2009,25(8):722-723. doi:10. 3760/cma. j.issn. 1001-8050. 2009. 08. 230.
[24]袁瑞斌.跟骨重建钢板加植骨治疗跟骨关节内骨折[J].局解手术学杂志,2010,19(2):70. doi:10. 11659/jjssx. 1672-5042. 201002001.
[25]葛双雷,张亚奎,王雪飞. Donati-Allgower方法缝合跟骨骨折手术切口疗效分析[J].中国医药科学,2015,5(14):189-191.
[26]余江.不同缝合方法预防或减少跟骨骨折切口并发症的对比研究[J].实用医学杂志,2018,34(1):93-95. doi:10. 3969/j. issn.1006-5725. 2018. 01. 023.
[2]何国祥,潘月来,谢勤,等.跟骨骨折的CT检查及其价值[J].中华放射学杂志,1994,28(8):544.
[3]Talarico LM,Vito GR,Zyryanov SY. Management of displaced intraarticular calcaneal fractures by using external ring fixation,minimally invasive open reduction,and early weightbearing[J]. J Foot Ankle Surg,2004,43(1):43-50. doi:10. 1053/j. jfas. 2003. 11. 010.
[4]Erduran M,Akseki D,Ulusal AE. A complication due to shock wave therapy resembling calcaneal stress fracture[J]. Foot Ankle Int,2013,34(4):599-602. doi:10. 1177/1071100712470917.
[5]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. doi:10. 3969/j. issn. 2095-4344. 2015. 09. 019.
[6]冯云华,谭广毅,文明,等.跟骨骨折术后皮肤坏死创面的修复[J].中国矫形外科杂志,2011,19(10):872-874. doi:10. 3977/j.issn. 1005-8478. 2011. 10. 26.
[7]沙宇,朱军方,杨树东,等.跟骨关节内骨折手术治疗并发症原因分析及防治[J].中国骨与关节损伤杂志,2006,21(2):153-154.doi:10. 3969/j. issn. 1672-9935. 2006. 02. 043.
[8]俞光荣,燕晓宇.跟骨骨折治疗方法的选择[J].中华骨科杂志,2006,26(2):134-141. doi:10. 3760/j. issn:0253-2352. 2006. 02. 019.
[9]王军,王玉兰,焦磊,等.跟骨关节内骨折手术治疗临床分析[J].局解手术学杂志,2011,20(5):538-539. doi:10. 3969/j.issn. 1672-5042. 2011. 05. 033.
[10]梁宏伟,余磊,赵斌,等.经皮撬拨内固定与切开复位内固定治疗跟骨骨折的比较[J].黑龙江医药,2016,29(5):986-988. doi:10. 1403/j. cnki. hljyy. 2016. 05. 091.
[11]Pang QJ,Yu X,Guo ZH. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture:A finite element analysis[J]. Pak J Med Sci,2014,30(5):1099-1103. doi:10. 12669/pjms. 305. 5301.
[12]Palmersheim K,Hines B,Olsen BL. Calcaneal fractures:update on current treatments[J]. Clin Podiatr Med Surg,2012,29(2):205-220. doi:10. 1016/j. cpm. 2012. 01. 007.
[13]Court-Brown CM,Schmied M,Schutte BG. Factors affecting infection after calcaneal fracture fixation[J]. Injury,2009,40(12):1313-1315. doi:10. 1016/j. injury. 2009. 03. 044.
[14]Bergin PF,Psaradellis T,Krosin MT,et al. Inpatient soft tissue protocol and wound complications in calcaneus fractures[J]. Foot Ankle Int,2012,33(6):492-497. doi:1016/j. injury. 2009. 03. 044.
[15]沙良宽,田家祥,李敬祥,等.撬拨复位与切开复位内固定治疗SandersⅡ型跟骨骨折的比较[J].中国修复重建外科杂志,2015,29(5):558-562. doi:10. 7507/1002-1892. 20150121.
[16]黄世超,倪锋,魏广奇,等.经皮撬拨复位空心螺钉与切开复位钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效比较[J].中国临床研究,2017,30(6):813-815. doi:10. 13429/j. cnki. cjcr. 2017. 06. 027.
[17]刘亮,周恩瑜,陈宇.经皮撬拨复位空心螺钉内固定SandersⅡ、Ⅲ型跟骨骨折[J].局解手术学杂志,2018,27(8):581-585.doi:10. 11659/jjssx. 01E018051.
[18]方志强.外踝下小切口结合微型锁定钢板治疗跟骨骨折体会[J].中国矫形外科杂志,2015,23(18):1722-1724. doi:10. 3977/j.issn. 1005-8478. 2015. 18. 21.
[19]缪逸鸣,王强,沈影超,等.“八”字双切口钢板内固定治疗跟骨骨折的临床疗效分析[J].中国临床医学,2018,25(1):95-99.doi:10. 12025/j. issn. 1008-6358. 2018. 20170408.
[20]吴旻昊.经微创跗骨窦切口入路与传统外侧L形切口入路比较治疗跟骨骨折的Meta分析[J].中国骨伤,2017,30(12):1118-1126. doi:10. 3969/j. issn. 1003-0034. 2017. 12. 009.
[21]陈永岗,肖勋刚,危小东,等.跟骨骨折患者的微创经皮钢板固定技术治疗[J].中国骨与关节杂志,2017,6(11):833-836. doi:10.3969/j. issn. 2095-252X. 2017. 11. 008.
[22]马骏,何斌,姜曙祥,等.“八”字微创入路内固定治疗跟骨骨折疗效观察[J].局解手术学杂志,2017,26(4):256-259. doi:10.11659/jjssx. 09E016065.
[23]陈滔,王子明.减少跟骨骨折术后皮缘坏死和疼痛的手术技巧[J].中华创伤杂志,2009,25(8):722-723. doi:10. 3760/cma. j.issn. 1001-8050. 2009. 08. 230.
[24]袁瑞斌.跟骨重建钢板加植骨治疗跟骨关节内骨折[J].局解手术学杂志,2010,19(2):70. doi:10. 11659/jjssx. 1672-5042. 201002001.
[25]葛双雷,张亚奎,王雪飞. Donati-Allgower方法缝合跟骨骨折手术切口疗效分析[J].中国医药科学,2015,5(14):189-191.
[26]余江.不同缝合方法预防或减少跟骨骨折切口并发症的对比研究[J].实用医学杂志,2018,34(1):93-95. doi:10. 3969/j. issn.1006-5725. 2018. 01. 023.