改良外侧“L”型切口治疗Sanders Ⅳ型跟骨骨折的效果观察
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摘要
目的观察改良外侧"L"型切口对于SandersⅣ型跟骨骨折的临床疗效。方法 2014年6月—2017年6月淮安市第一人民医院一分院骨科行手术治疗的SandersⅣ型跟骨骨折患者68例,采用改良外侧"L"型切口(改良组)和传统"L"型切口进行手术治疗(传统组),每组34例。术后随访1年,记录并比较两组患者手术前后踝-后足评分(AOFAS)、手术时间、术中出血量、切口长度,术后1d和1年的B?hler角、Gissane角、跟骨高度及宽度,以及切口坏死、感染等并发症情况。结果改良组手术时间(73.2±10.4)min、切口长度(9.1±1.2)cm、术中出血量(91.3±8.5)mL均少于传统组,差异有统计学意义(P<0.05);改良组术后1d及1年B?hler角(32.5±4.8)°、(32.8±4.9)°,Gissane角(131.5±8.6)°、(131.6±7.8)°,跟骨高度(43.2±2.1)、(43.6±2.6)mm较传统组改善更显著,差异有统计学意义(P<0.05),跟骨宽度差异无统计学意义(P>0.05)。术后3个月,改良组出现切口感染渗出1例,总发生率为2.9%;传统组出现切口感染4例,切口坏死2例,总发生率为17.6%,差异有统计学意义(P<0.05)。术后1年随访,改良组优良率为94.1%,高于传统组的76.5%,差异有统计学意义(P<0.05)。结论改良外侧"L"型切口对SandersⅣ型跟骨骨折疗效显著,且并发症发生率低,值得临床推广应用。
Objective To observe the clinical effect of modified lateral "L" incision on Sanders type Ⅳ calcaneal fracture. Methods Totally 68 patients with Sanders type IV calcaneal fractures who underwent surgery in the Department of Orthopaedics,Huai'an First People's Hospital from Jun. 2014 to Jun. 2017,were treated with modified lateral "L" incision(modified group) and traditional "L" incision(traditional group),with 34 cases in each group. All patients underwent 1 year follow-up. The AOFAS(American Orthopedic Foot and Ankle Society) scores,operative time,intraoperative blood loss,length of incision and Bohler's angle,Gissane's angle,height and width of the calcaneus,and complications such as incision necrosis and infection at 1 d and 1 year postoperatively were compared. Results The operation time(73.2±10.4)min,the length of the incision(9.1±1.2)cm,and the intraoperative blood loss(91.3±8.5) mL of the modified group were less than those of the traditional group,The differences were statistically significant(P<0.05). The Bohler angle(32.5±4.8)°,(32.8±4.9)°,Gissane angle(131.5±8.6)°,(131.6±7.8)°,and calcaneus height(43.2±2.1) mm,(43.6±2.6)mm at 1 d and 1 year after operation in the modified group was more significant than those in the traditional group,and the differences were statistically significant(P<0.05).The difference in calcaneus width was not statistically significant(P>0.05). Three months after operation,one case of incision infection exudation occurred in the modified group,with a total incidence of 2.9%. In the traditional group,there were 4 cases of wound infection and 2 cases of incision necrosis,and the total incidence was 17.6%. The difference was statistically significant(P <0.05). After 1 year of follow-up,the excellent and good rate of the modified group was 94.1%,which was higher than that of the traditional group(76.5%). Conclusion The modified lateral "L" incision has significant effect on the treatment of Sanders type IV calcaneal fractures,and the incidence of complications is low,which is worthy of clinical application.
Objective To observe the clinical effect of modified lateral "L" incision on Sanders type Ⅳ calcaneal fracture. Methods Totally 68 patients with Sanders type IV calcaneal fractures who underwent surgery in the Department of Orthopaedics,Huai'an First People's Hospital from Jun. 2014 to Jun. 2017,were treated with modified lateral "L" incision(modified group) and traditional "L" incision(traditional group),with 34 cases in each group. All patients underwent 1 year follow-up. The AOFAS(American Orthopedic Foot and Ankle Society) scores,operative time,intraoperative blood loss,length of incision and Bohler's angle,Gissane's angle,height and width of the calcaneus,and complications such as incision necrosis and infection at 1 d and 1 year postoperatively were compared. Results The operation time(73.2±10.4)min,the length of the incision(9.1±1.2)cm,and the intraoperative blood loss(91.3±8.5) mL of the modified group were less than those of the traditional group,The differences were statistically significant(P<0.05). The Bohler angle(32.5±4.8)°,(32.8±4.9)°,Gissane angle(131.5±8.6)°,(131.6±7.8)°,and calcaneus height(43.2±2.1) mm,(43.6±2.6)mm at 1 d and 1 year after operation in the modified group was more significant than those in the traditional group,and the differences were statistically significant(P<0.05).The difference in calcaneus width was not statistically significant(P>0.05). Three months after operation,one case of incision infection exudation occurred in the modified group,with a total incidence of 2.9%. In the traditional group,there were 4 cases of wound infection and 2 cases of incision necrosis,and the total incidence was 17.6%. The difference was statistically significant(P <0.05). After 1 year of follow-up,the excellent and good rate of the modified group was 94.1%,which was higher than that of the traditional group(76.5%). Conclusion The modified lateral "L" incision has significant effect on the treatment of Sanders type IV calcaneal fractures,and the incidence of complications is low,which is worthy of clinical application.
引文
[1] 吴贤驹.切开复位钛合金钢板内固定法治疗Sanders Ⅲ～Ⅳ型跟骨骨折的临床疗效及安全性评价[J].中国现代药物应用,2017,11(5):46-47.
[2] 李玉茂,林智军,林奇益.切开复位钢板内固定治疗Sanders Ⅱ～Ⅳ型跟骨关节内骨折的疗效[J].中国骨与关节损伤杂志,2017,32(6):657-658.
[3] 郭晓辉,温建强,陈志维.小切口有内固定治疗关节面移位跟骨骨折的疗效评估[J].实用医学杂志,2014,30(8):1267-1269.
[4] Yu GR,Fan J,Zhou JQ,et al.Characteristics and surgical treatment of combined calcaneal fractures[J].Zhong Hua Wai Ke Za Zhi,2010,48(11):842-846.
[5] 聂涛,戴闽,邹帆,等.Gustilo Ⅲ型及Sanders Ⅳ型跟骨骨折的治疗[J].中国修复重建外科杂志,2015,29(6):787-788.
[6] 黎志超,薛勇.跗骨窦切口微创切开复位内固定治疗Sanders Ⅳ型跟骨骨折[J].中国骨与关节损伤杂志,2017,32(10):1104-1105.
[7] 张道鑫,韩庆斌,徐留海.经跗骨窦小切口与L形切口治疗Sanders Ⅱ、Ⅲ、Ⅳ型跟骨骨折疗效比较[J].临床骨科杂志,2018,21(3):357-360.
[8] 徐浩,蒋元斌,刘耀辉,等.传统外侧“L”形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药,2015,55(1):86-88.
[9] 杨振军,何新泽,孙勃,等.改良“L”型切口治疗跟骨骨折疗效及并发症相关因素研究[J].中国矫形外科杂志,2015,23(12):1123-1126.
[10] 孙昌俊,李力更,毕若杰,等.“L”入路与“八字”微创入路治疗跟骨骨折的比较[J].中国医学科学院学报,2015,37(6):733-736.
[11] 沈美华,施凯兵,张红,等.3D打印技术在Sanders Ⅲ、Ⅳ型跟骨骨折手术中的应用[J].中国矫形外科杂志,2018,26(14):1259-1263.
[12] Zhou YK,Zhang B,Hu TJ,et al.Lateral minimally invasive approach reduction and internal fixation with hollow screws for displaced intra-articular calcaneal fracture[J].Zhong Guo Gu Shang,2010,23(6):463-465.
[13] 李培源,陈辉,华祥,等.外侧扩大“L”形入路治疗移位关节内跟骨骨折的疗效评价[J].创伤外科杂志,2018,20(5):329-331.
[14] 刘洪达,曲平艳,高建华,等.改良“八”字切口治疗跟骨骨折合并腓骨肌腱滑脱的体会[J].中国骨与关节损伤杂志,2016,31(4):437-438.
[15] 程千,赵建忠,狄东华,等.改良切口与传统L形切口治疗跟骨骨折的临床疗效对比[J].实用医学杂志,2016,32(14):2374-2376.
[2] 李玉茂,林智军,林奇益.切开复位钢板内固定治疗Sanders Ⅱ～Ⅳ型跟骨关节内骨折的疗效[J].中国骨与关节损伤杂志,2017,32(6):657-658.
[3] 郭晓辉,温建强,陈志维.小切口有内固定治疗关节面移位跟骨骨折的疗效评估[J].实用医学杂志,2014,30(8):1267-1269.
[4] Yu GR,Fan J,Zhou JQ,et al.Characteristics and surgical treatment of combined calcaneal fractures[J].Zhong Hua Wai Ke Za Zhi,2010,48(11):842-846.
[5] 聂涛,戴闽,邹帆,等.Gustilo Ⅲ型及Sanders Ⅳ型跟骨骨折的治疗[J].中国修复重建外科杂志,2015,29(6):787-788.
[6] 黎志超,薛勇.跗骨窦切口微创切开复位内固定治疗Sanders Ⅳ型跟骨骨折[J].中国骨与关节损伤杂志,2017,32(10):1104-1105.
[7] 张道鑫,韩庆斌,徐留海.经跗骨窦小切口与L形切口治疗Sanders Ⅱ、Ⅲ、Ⅳ型跟骨骨折疗效比较[J].临床骨科杂志,2018,21(3):357-360.
[8] 徐浩,蒋元斌,刘耀辉,等.传统外侧“L”形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药,2015,55(1):86-88.
[9] 杨振军,何新泽,孙勃,等.改良“L”型切口治疗跟骨骨折疗效及并发症相关因素研究[J].中国矫形外科杂志,2015,23(12):1123-1126.
[10] 孙昌俊,李力更,毕若杰,等.“L”入路与“八字”微创入路治疗跟骨骨折的比较[J].中国医学科学院学报,2015,37(6):733-736.
[11] 沈美华,施凯兵,张红,等.3D打印技术在Sanders Ⅲ、Ⅳ型跟骨骨折手术中的应用[J].中国矫形外科杂志,2018,26(14):1259-1263.
[12] Zhou YK,Zhang B,Hu TJ,et al.Lateral minimally invasive approach reduction and internal fixation with hollow screws for displaced intra-articular calcaneal fracture[J].Zhong Guo Gu Shang,2010,23(6):463-465.
[13] 李培源,陈辉,华祥,等.外侧扩大“L”形入路治疗移位关节内跟骨骨折的疗效评价[J].创伤外科杂志,2018,20(5):329-331.
[14] 刘洪达,曲平艳,高建华,等.改良“八”字切口治疗跟骨骨折合并腓骨肌腱滑脱的体会[J].中国骨与关节损伤杂志,2016,31(4):437-438.
[15] 程千,赵建忠,狄东华,等.改良切口与传统L形切口治疗跟骨骨折的临床疗效对比[J].实用医学杂志,2016,32(14):2374-2376.