顺势复位理论结合微创接骨板内固定术治疗关节内移位跟骨骨折
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摘要
目的对移位需要切开复位内固定治疗的跟骨骨折运用"顺势复位"理论进行复位,结合微创接骨板内固定术(MIPO)及以桥接钢板内固定,探索提高此种类型跟骨骨折治疗效果的技巧。方法将2014年12月至2017年2月涉及关节面的跟骨骨折如跟骰骨折、跟距关节面压缩骨折和舌形骨折的27例患者纳入观察,采取跟骨后外侧纵行切口、跟骨前方斜切口,运用"顺势复位"间接复位,以双小切口间软组织隧道技术和桥接钢板原理予以解剖锁定钢板内固定。观察骨折和软组织愈合情况,以AOFAS踝及足功能评分系统评价术后功能。结果 27例患者均获得随访,术后时间为12～16个月,AOFAS踝及足功能评分优17例、良8例、可2例,总优良率约92. 5%。术后未出现切口感染、皮瓣坏死等软组织相关并发症。结论运用"顺势复位"理论进行复位,结合MIPO技术及以桥接钢板内固定治疗关节内移位的跟骨骨折,可有效减少干预性次生损伤,是跟骨骨折切开复位内固定可选择的手术技巧。
Objective To improve the curative effect of homeopathic bidirection-traction reduction device combined with minimally invasive bone plate fixation and bridging plate internal fixation for patients of calcaneal fracture with displacement. Methods From December2014 to February 2017,a total of 27 patients with calcaneal fractures like calcaneocuboid joint,calcaneal talus joint and tongue fracture were selected as research object,patients with the appropriate type of calcaneal fractures adopt a longitudinal incision with posterolateral bone,calcaneal oblique incision ahead,with joint fracture with the method of homeopathic bidirection-traction reduction device with a double incision technology and principle of bridge steel tunnel anatomic locking plate internal fixation. The healing of fracture and soft tissue were observed,and the postoperative function with AOFAS ankle and foot function scoring system were evaluated. Results Postoperative follow-up of 12-16 months,27 cases received follow-up. AOFAS ankle and foot function score result showed that 17 cases were excellent,8 cases were good,2 cases were fair,the excellent and good rate is about 92. 5%. There was no postoperative complications such as incision infection,skin flap necrosis and so on. Conclusion Homeopathic bidirection-traction reduction device combined with MIPO and bridging plate internal fixation for calcaneal fracture with intra-articular displacement can significantly reduce related complication rate,which can be optional surgical technique of open reduction and internal fixation for calcaneal fracture.
Objective To improve the curative effect of homeopathic bidirection-traction reduction device combined with minimally invasive bone plate fixation and bridging plate internal fixation for patients of calcaneal fracture with displacement. Methods From December2014 to February 2017,a total of 27 patients with calcaneal fractures like calcaneocuboid joint,calcaneal talus joint and tongue fracture were selected as research object,patients with the appropriate type of calcaneal fractures adopt a longitudinal incision with posterolateral bone,calcaneal oblique incision ahead,with joint fracture with the method of homeopathic bidirection-traction reduction device with a double incision technology and principle of bridge steel tunnel anatomic locking plate internal fixation. The healing of fracture and soft tissue were observed,and the postoperative function with AOFAS ankle and foot function scoring system were evaluated. Results Postoperative follow-up of 12-16 months,27 cases received follow-up. AOFAS ankle and foot function score result showed that 17 cases were excellent,8 cases were good,2 cases were fair,the excellent and good rate is about 92. 5%. There was no postoperative complications such as incision infection,skin flap necrosis and so on. Conclusion Homeopathic bidirection-traction reduction device combined with MIPO and bridging plate internal fixation for calcaneal fracture with intra-articular displacement can significantly reduce related complication rate,which can be optional surgical technique of open reduction and internal fixation for calcaneal fracture.
引文
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[16]张英泽.骨折顺势复位固定理论在创伤骨科中的应用[J].中华创伤杂志,2017,33(7):577-580. doi:10. 3760/cma. j. issn. 1001-8050. 2017. 07. 001.
[17]丛锐军,仇荣敏,刘俊峰,等.顺势牵引复位技术治疗股骨干骨折的前瞻性随机对照临床试验[J/CD].中华老年骨科与康复电子杂志,2018,4(4):193-197. doi:10. 3877/cma. j. issn. 2096-0263.2018. 04. 001.
[18]陈杰,曹立海,李绍光,等.粉碎性跟骨骨折手术切口的选择[J].中国骨与关节损伤杂志,2013,28(12):1206-1207. doi:10. 14163/j. cnki. 11-5547/r. 2018. 29. 013.
[19]叶丹丹,李升,侯志勇,等.牵引复位器治疗四肢长骨骨折的生物力学特性分析[J].河北医科大学学报,2017,38(10):1229-1231. doi:10. 3969/j. issn. 1007-3205. 2017. 10. 028.
[20]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.
[21]朱学敏.跟骨骨折复位质量与疗效评价分析[J].中国矫形外科杂志,2014,22(6):524-527. doi:10. 3977/j. issn. 1005-8478. 2014.06. 10.
[22]沈影超,王强,顾云峰,等.桥接钢板技术治疗不稳定性髋臼骨折临床效果分析[J].局解手术学杂志,2016,25(12):883-886. doi:10. 11659/jjssx. 05E016066.
[23]汤世斌.髂腹股沟联合髋关节后入路“隧道式会师”复位治疗复杂髋臼骨折[J].吉林医学,2011,32(23):4830-4831. doi:10. 3969/j. issn. 1004-0412. 2011. 23. 076.
[24]魏民,刘玉杰,王志刚,等.距骨骨软骨损伤逆行钻孔的临床疗效分析[J].解放军医学院学报,2014,35(1):44-45. doi:10. 3969/j. issn. 2095-5227. 2014. 01. 014.
[2]张英泽,韩志杰,刘欢,等.河北医科大学第三医院骨折治疗理念与原则[J].河北医科大学学报,2017,38(9):1093-1095. doi:10.3969/j. issn. 1007-3205. 2017. 09. 025.
[3]Wei N,Yuwen P,Liu W,et al. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures:A meta-analysis of current evidence base[J]. Medicine,2017,96(49):e9027. doi:10. 1097/MD. 0000000000009027.
[4]周俊,陈武,谢贵杰,等.跟骨骨折内固定术后皮肤软组织并发症可能原因及预防[J].中国实验诊断学,2013,17(11):2085-2086. doi:1007-4287(2013)11-2085-02.
[5]任静,韩愚弟,白云,等.足底内侧皮瓣修复足跟负重区组织缺损的疗效观察[J].解放军医学院学报,2017,38(8):738-740.doi:10. 3969/j. issn. 2095-5227. 2017. 08. 008.
[6]徐生根,肖坚,吴维剑.软组织损伤评估处理对跟骨骨折术后感染的意义[J].中国中西医结合外科杂志,2016(1):21-23. doi:10.3969/j. issn. 1007-6948. 2016. 01. 006.
[7] Sanders R,Vaupel ZM,Erdogan M,et al. Operative treatment of displaced intraarticular calcaneal fractures:long-term(10-20 Years)results in 108 fractures using a prognostic CT classification[J]. J Orthop Trauma,2014,28(10):551. doi:10. 1097/BOT. 0000000000000169.
[8] Rammelt S,Amlang M,Barthel S,et al. Percutaneous treatment of less severe intraarticular calcaneal fractures[J]. Clin Orthop Relat Res,2010,468(4):983-990. doi:10. 1007/s11999-009-0964-x.
[9]迪力夏提·多力坤,郑龙坡.顺势复位治疗胫骨平台骨折的临床研究[J/CD].中华老年骨科与康复电子杂志,2018,4(3):163-167.doi:10. 3877/cma. j. issn. 2096-0263. 2018. 03. 008.
[10]Zhang F,Tian H,Li S,et al. Meta-analysis of two surgical approaches for calcaneal fractures:sinus tarsi versus extensile lateral approach[J]. Anz J Surg,2017,87(3):126-136. doi:10. 1111/ans. 13869.
[11]孙伟,黄国伟,韦山,等.经跗骨窦切口空心螺钉内固定治疗舌型跟骨骨折[J].中华骨与关节外科杂志,2015,8(1):81-83. doi:10. 3969/j. issn. 2095-9958. 2015. 01-016.
[12]李来峰,王辉,赵仪云,等.跗骨窦切口联合经皮置钉技术微创治疗SandersⅢ型跟骨骨折[J].中国矫形外科杂志,2015,23(20):1850-1853. doi:10. 3977/j. issn. 1005-8478. 2015. 20. 06.
[13]吴旻昊,孙文超,闫飞飞,等.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.
[14]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.
[15]曾宪涛,冷卫东,李胜,等.如何正确理解及使用GRADE系统[J].中国循证医学杂志,2011,11(9):985-990. doi:10. 3969/j.issn. 1672-2531. 2011. 09. 002.
[16]张英泽.骨折顺势复位固定理论在创伤骨科中的应用[J].中华创伤杂志,2017,33(7):577-580. doi:10. 3760/cma. j. issn. 1001-8050. 2017. 07. 001.
[17]丛锐军,仇荣敏,刘俊峰,等.顺势牵引复位技术治疗股骨干骨折的前瞻性随机对照临床试验[J/CD].中华老年骨科与康复电子杂志,2018,4(4):193-197. doi:10. 3877/cma. j. issn. 2096-0263.2018. 04. 001.
[18]陈杰,曹立海,李绍光,等.粉碎性跟骨骨折手术切口的选择[J].中国骨与关节损伤杂志,2013,28(12):1206-1207. doi:10. 14163/j. cnki. 11-5547/r. 2018. 29. 013.
[19]叶丹丹,李升,侯志勇,等.牵引复位器治疗四肢长骨骨折的生物力学特性分析[J].河北医科大学学报,2017,38(10):1229-1231. doi:10. 3969/j. issn. 1007-3205. 2017. 10. 028.
[20]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.
[21]朱学敏.跟骨骨折复位质量与疗效评价分析[J].中国矫形外科杂志,2014,22(6):524-527. doi:10. 3977/j. issn. 1005-8478. 2014.06. 10.
[22]沈影超,王强,顾云峰,等.桥接钢板技术治疗不稳定性髋臼骨折临床效果分析[J].局解手术学杂志,2016,25(12):883-886. doi:10. 11659/jjssx. 05E016066.
[23]汤世斌.髂腹股沟联合髋关节后入路“隧道式会师”复位治疗复杂髋臼骨折[J].吉林医学,2011,32(23):4830-4831. doi:10. 3969/j. issn. 1004-0412. 2011. 23. 076.
[24]魏民,刘玉杰,王志刚,等.距骨骨软骨损伤逆行钻孔的临床疗效分析[J].解放军医学院学报,2014,35(1):44-45. doi:10. 3969/j. issn. 2095-5227. 2014. 01. 014.