透视下小切口骨刀撬拨治疗跟骨骨折的临床应用研究
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摘要
目的探讨C臂机透视下跟骨骨折跗骨窦区小切口骨刀经骨折间隙撬拨复位经皮螺钉内固定的临床研究。方法收集40例跟骨骨折作为研究对象,其中20例患者采用传统切开复位内固定手术来进行治疗作为对照组;另外20例患者则采用C臂机透视下跗骨窦区小切口骨刀经骨折间隙撬拨复位经皮空心螺钉内固定来进行治疗作为观察组。对比两组患者治疗效果,然后对两组患者的手术时间、住院时间、住院费用、手术后的疼痛程度、B?hler角、Gissane角进行对比,最后观察在治疗后两组患者出现局部皮瓣坏死感染的发生率及治疗效果的优良率。结果观察组手术时间、住院时间、住院平均费用均明显少于对照组,观察组手术后的疼痛程度明显轻于对照组,差异均有统计学意义(<0.05)。两组患者术后B?hler角、Gissane角的恢复情况,差异无统计学意义(>0.05)。观察组中,在手术后未出现局部皮瓣坏死感染。对照组中,在手术后出现局部皮瓣坏死的患者有4例,占20%,组间差异有统计学意义(<0.05)。两组优良率对比差异不大,无统计学意义。结论采用C臂机透视下跟骨骨折跗骨窦区小切口骨刀经骨折间隙撬拨复位经皮螺钉内固定术来治疗跟骨骨折,手术创伤小、时间短、住院费用较少,并能有效地避免传统切开复位内固定引起的局部皮瓣坏死感染等并发症,能取得非常理想的临床效果,患者伤口美观,值得临床推广。
Objective To explore the clinical study of small incision osteotomy prying to treat calcaneal fractures throughinterfracture space under the c-arm X-ray perspective. Methods A total of 40 calcaneal fractures were collected as subjects,of which 20 patients were treated with traditional open restoration and internal fixation as the control group. Another 20 patients were treated with the small incision osteotomy prying restoration and hollow screw internal fixation through interfracture space in the sinus of the tarsal bone under the c-arm X-ray perspective as the observation group. The treatment effect of the two groups of patients was compared, and then the operation time, hospitalization time, hospitalization expenses, postoperative pain degree, B?hler angle and Gissane angle were compared, and finally the incidence rate of local skin flap necrosis infection and the excellent and good rate of treatment effect were observed. Results The operation time, hospitalization time and average hospitalization cost of the observation group were significantly lower than those of the control group, and the pain degree of the observation group was significantly lower than that of the control group,with statistically significant differences( <0.05). Postoperative recovery of B?hler angle and Gissane angle was not statistically significant( >0.05). In the observation group, local skin flap necrosis and incision infection did not appear after surgery. In the control group, there were 4 cases of local skin flap necrosis after surgery, accounting for 20%, and the difference between the groups was statistically significant( <0.05). There was no significant difference in excellent and good rate between the two groups. Conclusion The treatment of calcaneal fractures with the small incision osteotomy prying restoration and hollow screw internal fixation through interfracture space in the sinus of the tarsal bone under the c-arm X-ray perspective, small surgical trauma, short time and hospitalization costs less, and can effectively avoid the traditional open reduction and internal fixation of local skin flap necrosis caused by complications such as infection, can obtain ideal clinical effect, bring patients beauty appearance, worth clinical promotion.
Objective To explore the clinical study of small incision osteotomy prying to treat calcaneal fractures throughinterfracture space under the c-arm X-ray perspective. Methods A total of 40 calcaneal fractures were collected as subjects,of which 20 patients were treated with traditional open restoration and internal fixation as the control group. Another 20 patients were treated with the small incision osteotomy prying restoration and hollow screw internal fixation through interfracture space in the sinus of the tarsal bone under the c-arm X-ray perspective as the observation group. The treatment effect of the two groups of patients was compared, and then the operation time, hospitalization time, hospitalization expenses, postoperative pain degree, B?hler angle and Gissane angle were compared, and finally the incidence rate of local skin flap necrosis infection and the excellent and good rate of treatment effect were observed. Results The operation time, hospitalization time and average hospitalization cost of the observation group were significantly lower than those of the control group, and the pain degree of the observation group was significantly lower than that of the control group,with statistically significant differences( <0.05). Postoperative recovery of B?hler angle and Gissane angle was not statistically significant( >0.05). In the observation group, local skin flap necrosis and incision infection did not appear after surgery. In the control group, there were 4 cases of local skin flap necrosis after surgery, accounting for 20%, and the difference between the groups was statistically significant( <0.05). There was no significant difference in excellent and good rate between the two groups. Conclusion The treatment of calcaneal fractures with the small incision osteotomy prying restoration and hollow screw internal fixation through interfracture space in the sinus of the tarsal bone under the c-arm X-ray perspective, small surgical trauma, short time and hospitalization costs less, and can effectively avoid the traditional open reduction and internal fixation of local skin flap necrosis caused by complications such as infection, can obtain ideal clinical effect, bring patients beauty appearance, worth clinical promotion.
引文
[1] Palmersheim K,Hines B, Olsen BL. Calcaneal fractures:update on current treatments[J]. ClinPodiatr Med Surg,2012, 29(2):205-220.
[2]梁晓军,赵宏谋.跟骨骨折的临床治疗要点[J].中国骨伤, 2014,27(7):533-535.
[3] Kitauka HB, Alexander U, Adelaar RS, et al.Clinical rating systems for the ankle.Hindfoot, midfoot, hallux, and lesser toes[J].Foot Ankle Int, 1994, 15(7):349-353.
[4]游景扬,郑勇,陈园,等. SandersⅢ、Ⅳ型跟骨骨折手术疗效的回顾性分析[J].生物骨科材料与临床研究, 2015,12(5):44-46.
[5]李博,孙立,韩伟,等.外侧延长“L”形切口治疗跟骨骨折常见并发症及相关因素分析[J].中国矫形外科杂志,2017,25(2):178-180.
[6]陈明,邓葵,曾晚辉,等.微创跗骨窦小切口手法复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华外科杂志, 2017, 55(3):220-223.
[7]朱学敏,唐三元,杨辉.跟骨骨折的微创治疗现状[J].生物骨科材料与临床研究, 2014, 11(1):31-34.
[8] DeWall M, Henderson CE, McKinley TO, et al. Percutaneous reduction andfixation of displaced intra-articular caleaneus fractures[J]. J Orthop Trauma, 2010, 24(8):466-472.
[9]孟乾,刘玉平.两种微创内固定手术治疗SandersⅡ型跟骨骨折的疗效比较[J].中国冶金工业医学杂志, 2018, 35(4):376-378.
[10]何晓宇,王朝强,周之平.经皮微创撬拨复位空心钉内固定治疗跟骨骨折疗效分析[J].中国骨伤, 2016, 29(5):421-423.
[11]赵飞,李存祥,张剑刚,等.微创手术治疗跟骨关节内骨折疗效分析[J].实用骨科杂志, 2014, 20(9):854-857.
[2]梁晓军,赵宏谋.跟骨骨折的临床治疗要点[J].中国骨伤, 2014,27(7):533-535.
[3] Kitauka HB, Alexander U, Adelaar RS, et al.Clinical rating systems for the ankle.Hindfoot, midfoot, hallux, and lesser toes[J].Foot Ankle Int, 1994, 15(7):349-353.
[4]游景扬,郑勇,陈园,等. SandersⅢ、Ⅳ型跟骨骨折手术疗效的回顾性分析[J].生物骨科材料与临床研究, 2015,12(5):44-46.
[5]李博,孙立,韩伟,等.外侧延长“L”形切口治疗跟骨骨折常见并发症及相关因素分析[J].中国矫形外科杂志,2017,25(2):178-180.
[6]陈明,邓葵,曾晚辉,等.微创跗骨窦小切口手法复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华外科杂志, 2017, 55(3):220-223.
[7]朱学敏,唐三元,杨辉.跟骨骨折的微创治疗现状[J].生物骨科材料与临床研究, 2014, 11(1):31-34.
[8] DeWall M, Henderson CE, McKinley TO, et al. Percutaneous reduction andfixation of displaced intra-articular caleaneus fractures[J]. J Orthop Trauma, 2010, 24(8):466-472.
[9]孟乾,刘玉平.两种微创内固定手术治疗SandersⅡ型跟骨骨折的疗效比较[J].中国冶金工业医学杂志, 2018, 35(4):376-378.
[10]何晓宇,王朝强,周之平.经皮微创撬拨复位空心钉内固定治疗跟骨骨折疗效分析[J].中国骨伤, 2016, 29(5):421-423.
[11]赵飞,李存祥,张剑刚,等.微创手术治疗跟骨关节内骨折疗效分析[J].实用骨科杂志, 2014, 20(9):854-857.