单侧前内侧切口和双侧切口入路在距骨颈骨折中的疗效对比
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摘要
目的对比单侧前内侧切口和双侧切口入路在治疗距骨颈骨折中的疗效。方法选取2010年6月至2016年6月因距骨颈骨折于本院接受手术治疗的86名患者为研究对象。将全部患者随机分为采用前内侧切口入路的前内侧组和采用双侧切口入路的双侧组各43例,对比两组患者的术后一年内的治疗效果。结果前内侧组术后1年的愈合率93.02%,双侧组愈合率67.44%,差异有统计学意义(P<0.05);前内侧组的创伤性关节炎发生率37.21%,双侧组关节炎发生率11.63%,差异有统计学意义(P<0.05);两组患者缺血性股骨头坏死发生率和术后一年的疗效优良率对比,差异无统计学意义(P>0.05);前内侧组的VAS评分(5.98±0.96)显著高于双侧组(3.61±0.33),差异有统计学意义(P<0.05)。结论对于距骨颈骨折患者,单侧前内侧切口入路较双侧切口入路能更好地保护患者手术位置的血供系统,提高术后愈合率;而双侧切口入路则能在手术时取得更好的视野,有助于彻底清除骨折碎片,取得更好的复位效果。临床治疗时可根据患者的具体情况和侧重点不同,灵活选择入路方式,提高手术效果。
Objective To study the curative effect of unilateral anterior incision and bilateral incision approach in the clinical treatment of talar neck fracture.Methods From June 2015 to June 2016,86 patients with talus neck fractures underwent surgical treatment were enrolled in this study.All patients were divided into anterior medial group with anterior medial incision approach and 43 patients with bilateral incision approach.The results of the two groups were compared within one year after operation.Results The healing rate of the anterolateral group was 93.02% which was higher than that of the bilateral group(67.44% ),the difference was statistically significant(P<0.05).The rate of traumatic arthritis in the anterolateral group was significantly higher than that in the bilateral group(P<0.05).The incidence of ischemic necrosis of femoral head and the excellent and good rate after 1-year follow-up had no significant difference(P>0.05).The score of VAS was(5.98±0.96),which was significantly higher than that of bilateral group(3.61±0.33),the difference was statistically significant(P<0.05).Conclusion In the clinical treatment of talus neck fracture,unilateral anterior medial incision approach can better protect the patient's surgical location of the system to improve the rate of postoperative healing than the bilateral incision approach.The double lateral incision approach can expose a better vision during surgery,help to completely clear the fragments and achieve a better reset effect.Clinical treatment can be based on the specific circumstances of patients and focus on different,flexible way to choose to improve the surgical results.
Objective To study the curative effect of unilateral anterior incision and bilateral incision approach in the clinical treatment of talar neck fracture.Methods From June 2015 to June 2016,86 patients with talus neck fractures underwent surgical treatment were enrolled in this study.All patients were divided into anterior medial group with anterior medial incision approach and 43 patients with bilateral incision approach.The results of the two groups were compared within one year after operation.Results The healing rate of the anterolateral group was 93.02% which was higher than that of the bilateral group(67.44% ),the difference was statistically significant(P<0.05).The rate of traumatic arthritis in the anterolateral group was significantly higher than that in the bilateral group(P<0.05).The incidence of ischemic necrosis of femoral head and the excellent and good rate after 1-year follow-up had no significant difference(P>0.05).The score of VAS was(5.98±0.96),which was significantly higher than that of bilateral group(3.61±0.33),the difference was statistically significant(P<0.05).Conclusion In the clinical treatment of talus neck fracture,unilateral anterior medial incision approach can better protect the patient's surgical location of the system to improve the rate of postoperative healing than the bilateral incision approach.The double lateral incision approach can expose a better vision during surgery,help to completely clear the fragments and achieve a better reset effect.Clinical treatment can be based on the specific circumstances of patients and focus on different,flexible way to choose to improve the surgical results.
引文
[1]毛建水,叶招明.距骨骨折后缺血坏死的相关因素分析[J].中国骨伤,2015,28(4):368-370.
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[3]张鹏,董启榕,王宗允,等.内、外侧双切口结合Herbert螺钉内固定治疗合并同侧踝关节骨折的HawkinsⅢ型距骨颈骨折[J].中华医学杂志,2016,96(41):3342-3346.
[4]Robinson KP,Davies MB.Talus avulsion fractures:Are they accurately diagnosed?[J].Injury-international Journal of the Care of the Injured,2015,46(10):2016-2018.
[5]Young KW,Park YU,Kim JS,et al.Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas[J].Clinics in Orthopedic Surgery,2016,8(3):303-309.
[6]Wu K,Zhou Z,Huang J,et al.Talar Neck Fractures Treated Using a Highly Selective Incision:A Case-Control Study and Review of the Literature.[J].Journal of Foot&Ankle Surgery,2016,55(3):450-455.
[7]Alton T,Patton DJ,Gee AO.Classifications in Brief:The Hawkins Classification for Talus Fractures.[J].Clinical Orthopaedics&Related Research,2015,473(9):3046-3049.
[8]Maceroli MA,Wong C,Sanders RW,et al.Treatment of Comminuted Talar Neck Fractures With Use of Minifragment Plating[J].Journal of Orthopaedic Trauma,2016,30(10):572-573.
[9]吕业朋.可吸收钉治疗距骨骨折20例临床体会[J].大家健康:学术版,2015(15):98-99.
[10]王志元.中药内服外洗对距骨骨折的临床疗效分析[J].当代医学,2015(7):152-153.
[11]张文广.基于28例距骨颈骨折的急诊微创手术临床治疗效果回顾[J].中国伤残医学,2017,25(4):57-58.
[12]李兵,杨云峰,陈凯,等.内外侧联合入路治疗伴距骨脱位的距骨颈骨折[J].中华创伤杂志,2015,31(2):107-110.
[13]李元洲,李振,孙雨.距骨颈骨折的治疗体会[J].中国实用医药,2016,11(36):77-78.
[14]Kalmet P,Sanduleanu S,Horn YV,et al.Is early Weight Bearing Allowed in Surgically Treated Talar Neck Fractures?[J].Journal of Orthopaedic Case Reports,2016,6(3):73-74.
[15]湛世本,麦鸿飞.HawkinsⅢ型距骨颈骨折内、外双侧切口联合空心拉力螺钉内固定急诊治疗的应用[J].中国医学创新,2015(24):122-125.
[2]佟殿良.切开复位内固定手术治疗开放距骨骨折的临床分析[J].中国继续医学教育,2016,8(13):98-99.
[3]张鹏,董启榕,王宗允,等.内、外侧双切口结合Herbert螺钉内固定治疗合并同侧踝关节骨折的HawkinsⅢ型距骨颈骨折[J].中华医学杂志,2016,96(41):3342-3346.
[4]Robinson KP,Davies MB.Talus avulsion fractures:Are they accurately diagnosed?[J].Injury-international Journal of the Care of the Injured,2015,46(10):2016-2018.
[5]Young KW,Park YU,Kim JS,et al.Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas[J].Clinics in Orthopedic Surgery,2016,8(3):303-309.
[6]Wu K,Zhou Z,Huang J,et al.Talar Neck Fractures Treated Using a Highly Selective Incision:A Case-Control Study and Review of the Literature.[J].Journal of Foot&Ankle Surgery,2016,55(3):450-455.
[7]Alton T,Patton DJ,Gee AO.Classifications in Brief:The Hawkins Classification for Talus Fractures.[J].Clinical Orthopaedics&Related Research,2015,473(9):3046-3049.
[8]Maceroli MA,Wong C,Sanders RW,et al.Treatment of Comminuted Talar Neck Fractures With Use of Minifragment Plating[J].Journal of Orthopaedic Trauma,2016,30(10):572-573.
[9]吕业朋.可吸收钉治疗距骨骨折20例临床体会[J].大家健康:学术版,2015(15):98-99.
[10]王志元.中药内服外洗对距骨骨折的临床疗效分析[J].当代医学,2015(7):152-153.
[11]张文广.基于28例距骨颈骨折的急诊微创手术临床治疗效果回顾[J].中国伤残医学,2017,25(4):57-58.
[12]李兵,杨云峰,陈凯,等.内外侧联合入路治疗伴距骨脱位的距骨颈骨折[J].中华创伤杂志,2015,31(2):107-110.
[13]李元洲,李振,孙雨.距骨颈骨折的治疗体会[J].中国实用医药,2016,11(36):77-78.
[14]Kalmet P,Sanduleanu S,Horn YV,et al.Is early Weight Bearing Allowed in Surgically Treated Talar Neck Fractures?[J].Journal of Orthopaedic Case Reports,2016,6(3):73-74.
[15]湛世本,麦鸿飞.HawkinsⅢ型距骨颈骨折内、外双侧切口联合空心拉力螺钉内固定急诊治疗的应用[J].中国医学创新,2015(24):122-125.