闭合复位锁定接骨板内固定与切开复位接骨板内固定治疗跟骨骨折对比研究
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摘要
目的探讨闭合复位锁定接骨板内固定与切开复位接骨板内固定治疗跟骨骨折的临床效果。方法回顾分析2014年6月至2016年9月该院骨科收治的60例跟骨骨折患者的临床资料,将其分为对照组(切开复位接骨板内固定,30例)和观察组(闭合复位锁定接骨板内固定,30例)。比较2组患者手术时间、住院时间、治疗费用、骨折愈合时间、术后视觉模拟疼痛(VAS)评分及手术前后放射学指标(Bohler角、Gissane角)变化,采用Maryland足部评分系统(MFS)对足部功能恢复情况进行疗效评估。结果观察组术后功能恢复优良率为86.67%,与对照组(70.00%)比较,差异无统计学意义(χ~2=1.571,P=0.210)。观察组住院时间和骨折愈合时间明显较对照组明显缩短(P<0.05);观察组患者术后3dVAS明显低于对照组(P<0.05)。2组患者术后Bohler角和Gissane角均较术前明显改善,差异有统计学意义(P<0.05),但2组各时间点Bohler角和Gissane角比较,差异均无统计学意义(P>0.05)。2组术后并发症总发生率比较,差异无统计学意义(P>0.05),但对照组切口感染及切口处皮肤坏死率明显高于观察组,差异有统计学意义(P<0.05)。结论闭合复位锁定接骨板内固定与切开复位接骨板内固定均是治疗跟骨骨折的有效术式,但闭合复位锁定接骨板内固定能够有效减轻患者疼痛,缩短住院时间和骨折愈合时间,有效避免切口感染等并发症的发生。
Objective To investigate the clinical effect of closed reduction and locking plate fixation and open reduction and internal fixation for the treatment of calcaneal fractures.Methods The clinical data of 60 patients with calcaneal fractures treated in Chinese Traditional Medicine Hospital of Baoji City from June 2014 to September 2016 were divided into control group(open reduction of the bone plate internal fixation,30 cases)and observation group(closed resetting and locking plate fixation,30 cases).The operative time,hospitalization time,treatment cost,fracture healing time,postoperative VAS score and radiographic parameters(Bohler angle,Gissane angle)were compared between the two groups.The Maryland Foot Score System(MFS)was used to evaluate the efficacy of the situation.Results The excellent rate of postoperative functional recovery was 86.67%,which showed no significant difference with the control group(70.00%,χ~2=1.571,P=0.210).The time of hospitalization and fracture healing were significantly shorter in the observation group than those in the control group(P<0.05),and the VAS score of the observation group was significantly lower than that of the control group at 3 days(P<0.05).The Bohler angle and Gissane angle of the two groups were significantly improved compared with preoperation,the differences were statistically significant(P<0.05).However,there were no significant differences on Bohler angle and Gissane angle between the two groups at each time point(P>0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05),but the rate of incisional infection and incision skin necrosis in the control group was significantly higher than that in the observation group(P<0.05).Conclusion Closed reduction and locking plate fixation and open reduction and internal fixation are both effective methods for the treatment of calcaneal fractures.However,closed reduction and locking plate fixation could effectively relieve pain,shorten the hospitalization time and fracture healing time,avoid wound infection and other complications.
Objective To investigate the clinical effect of closed reduction and locking plate fixation and open reduction and internal fixation for the treatment of calcaneal fractures.Methods The clinical data of 60 patients with calcaneal fractures treated in Chinese Traditional Medicine Hospital of Baoji City from June 2014 to September 2016 were divided into control group(open reduction of the bone plate internal fixation,30 cases)and observation group(closed resetting and locking plate fixation,30 cases).The operative time,hospitalization time,treatment cost,fracture healing time,postoperative VAS score and radiographic parameters(Bohler angle,Gissane angle)were compared between the two groups.The Maryland Foot Score System(MFS)was used to evaluate the efficacy of the situation.Results The excellent rate of postoperative functional recovery was 86.67%,which showed no significant difference with the control group(70.00%,χ~2=1.571,P=0.210).The time of hospitalization and fracture healing were significantly shorter in the observation group than those in the control group(P<0.05),and the VAS score of the observation group was significantly lower than that of the control group at 3 days(P<0.05).The Bohler angle and Gissane angle of the two groups were significantly improved compared with preoperation,the differences were statistically significant(P<0.05).However,there were no significant differences on Bohler angle and Gissane angle between the two groups at each time point(P>0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05),but the rate of incisional infection and incision skin necrosis in the control group was significantly higher than that in the observation group(P<0.05).Conclusion Closed reduction and locking plate fixation and open reduction and internal fixation are both effective methods for the treatment of calcaneal fractures.However,closed reduction and locking plate fixation could effectively relieve pain,shorten the hospitalization time and fracture healing time,avoid wound infection and other complications.
引文
[1]袁晓伟,李林,李青松.跟骨骨折治疗的研究进展[J].吉林医学,2016,37(1):178-180.
[2]黄宝林,廖红妹,朱永文,等.跟骨骨折手术治疗及保守治疗临床经验总结[J].现代诊断与治疗,2014,24(8):1827-1828.
[3]BACKES M,SCHEPERS T,BEEREKAMP M S,et al.Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach[J].Int Orthop,2014,38(4):767-773.
[4]李洪帅,李坤,张鹏.跟骨骨折的微创治疗与切开复位内固定术的对比研究[J].中国医药导报,2016,13(21):103-106.
[5]赖燕清,林乔龄.跟骨骨折治疗的研究进展[J].实用中西医结合临床,2016,16(6):86-88.
[6]李元洲,孙雨,姚亮.跟骨骨折的治疗体会及疗效观察[J].中国实用医药,2016,11(34):104-105.
[7]TAKASAKA M,BITTAR C K,MENNUCCI F S,et al.Comparative study on three surgical techniques for intraarticular calcaneal fractures:open reduction with internal fixation using aplate,external fixation and minimally invasive surgery[J].Rev Bras Ortop,2016,51(3):254-260.
[8]STAPLETON J J,ZGONIS T.Surgical treatment of intra-articular calcaneal fractures[J].Clin Podiatr Med Surg,2014,31(4):539.
[9]陆小庆,陈晓钢,张林,等.闭合复位微创锁定接骨板内固定治疗跟骨骨折[J/CD].中华临床医师杂志(电子版),2017,11(2):234-238.
[10]周明,金绍林,江建平,等.锁定接骨板内固定治疗移位的关节内跟骨骨折[J].临床骨科杂志,2015,18(3):362-364.
[11]于洪冰,孙巨文,王德建,等.切开复位支撑接骨板内固定治疗跟骨骨折的体会[J].河南外科学杂志,2016,22(1):103-104.
[12]谭新欢,聂伟志,隋显玉,等.闭合复位经皮穿针内固定与切开复位接骨板内固定治疗PaleyB1型跟骨骨折的对比研究[J].中医正骨,2015,27(12):16-19.
[13]郭琰,周方,田耘,等.闭合复位微创接骨板内固定治疗跟骨骨折[J].中华创伤骨科杂志,2015,17(3):238-242.
[14]GIANNINI S,CADOSSI M,MOSCA M,et al.Minimallyinvasive treatment of calcaneal fractures:a review of the literature and our experience[J].Injury,2016,47(Suppl4):S138-S146.
[15]张建发.经皮撬拨复位结合有限切开解剖钢板内固定治疗跟骨骨折[J].创伤外科杂志,2015,17(2):178.
[2]黄宝林,廖红妹,朱永文,等.跟骨骨折手术治疗及保守治疗临床经验总结[J].现代诊断与治疗,2014,24(8):1827-1828.
[3]BACKES M,SCHEPERS T,BEEREKAMP M S,et al.Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach[J].Int Orthop,2014,38(4):767-773.
[4]李洪帅,李坤,张鹏.跟骨骨折的微创治疗与切开复位内固定术的对比研究[J].中国医药导报,2016,13(21):103-106.
[5]赖燕清,林乔龄.跟骨骨折治疗的研究进展[J].实用中西医结合临床,2016,16(6):86-88.
[6]李元洲,孙雨,姚亮.跟骨骨折的治疗体会及疗效观察[J].中国实用医药,2016,11(34):104-105.
[7]TAKASAKA M,BITTAR C K,MENNUCCI F S,et al.Comparative study on three surgical techniques for intraarticular calcaneal fractures:open reduction with internal fixation using aplate,external fixation and minimally invasive surgery[J].Rev Bras Ortop,2016,51(3):254-260.
[8]STAPLETON J J,ZGONIS T.Surgical treatment of intra-articular calcaneal fractures[J].Clin Podiatr Med Surg,2014,31(4):539.
[9]陆小庆,陈晓钢,张林,等.闭合复位微创锁定接骨板内固定治疗跟骨骨折[J/CD].中华临床医师杂志(电子版),2017,11(2):234-238.
[10]周明,金绍林,江建平,等.锁定接骨板内固定治疗移位的关节内跟骨骨折[J].临床骨科杂志,2015,18(3):362-364.
[11]于洪冰,孙巨文,王德建,等.切开复位支撑接骨板内固定治疗跟骨骨折的体会[J].河南外科学杂志,2016,22(1):103-104.
[12]谭新欢,聂伟志,隋显玉,等.闭合复位经皮穿针内固定与切开复位接骨板内固定治疗PaleyB1型跟骨骨折的对比研究[J].中医正骨,2015,27(12):16-19.
[13]郭琰,周方,田耘,等.闭合复位微创接骨板内固定治疗跟骨骨折[J].中华创伤骨科杂志,2015,17(3):238-242.
[14]GIANNINI S,CADOSSI M,MOSCA M,et al.Minimallyinvasive treatment of calcaneal fractures:a review of the literature and our experience[J].Injury,2016,47(Suppl4):S138-S146.
[15]张建发.经皮撬拨复位结合有限切开解剖钢板内固定治疗跟骨骨折[J].创伤外科杂志,2015,17(2):178.