合拢下拉法治疗跟骨骨折的临床研究
摘要
目的:通过对合拢下拉法治疗跟骨骨折的临床研究,来探讨和研究合拢下拉法治疗跟骨骨折的临床疗效,为治疗跟骨骨折提供有力的临床研究和理论价值。
方法:收集2009年10月至2011年04月海城正骨医院住院病人18到65岁跟骨骨折患者,共80例,分为治疗组40例和对照组40例,通过对年龄、性别、患侧、骨折愈合时间、骨折类型进行比较,采用国际通用AOFAS(美国骨科学会足踝协会)踝后足评分标准进行评分对比。治疗组采用合拢下拉法治疗,对照组采用切开复位内固定治疗。分析比较两组骨折患者自述症状,足跟形态变化,X线侧位,轴位片变化,并做统计学处理。
结果:临床研究显示,治疗组:显效30例,占75.0%,有效6例,占15.0%,总有效率为90.0%。对照组:显效12例,占30.0%,有效18例,占45.0%,总有效率75.0%,治疗组总有效率明显优于对照组总有效率,经统计学分析,两组之间有明显差异(P≤0.01)。
结论:合拢下拉法较切开复位内固定治疗跟骨骨折临床疗效好,且安全简便,可靠实用。两组对比治疗组明显优于对照组,值得临床推广应用。
Objective: To shut down the clinical treatment of calcaneal fractures to close down law to explore and study the clinical efficacy of calcaneal fractures, calcaneal fractures to provide strong clinical research and theoretical value.
Methods: From October 2009 to April 2011 Haicheng and Traumatology Hospital in-patients aged 18 to 65 patients with fractures, a total of 80 patients, 40 patients were divided into treatment group and control group of 40 patients, by age, gender, injury side of the fracture healing time, type of fracture were compared, using internationally accepted standards AOFAS ankle hindfoot score rate comparison. The treatment group was closed down treatment in the control group treated with open reduction and internal fixation. Analysis of fracture patients were compared readme symptoms, morphological changes of the heel, X ray lateral, axial film changes, and to do statistical analysis.
Results: The clinical study showed that the treatment group: 30 cases markedly, accounting for 75.0%, effective in 6 cases, 15.0%, total effective rate was 90.0%. Control group: 12 cases markedly, accounting for 30.0%, effective in 18 cases, 45.0%, total effective rate was 75.0% , the efficiency of the treatment group was significantly better than the control group, the total efficiency of the statistical analysis, significantly between the two groups differences (P≤0.01).
Conclusion: Closure of the drop-down method is better than open reduction and internal fixation of calcaneal fractures is effective, safe and convenient, reliable and practical. The treatment group compared the two groups than the control group, worthy of clinical application.
方法:收集2009年10月至2011年04月海城正骨医院住院病人18到65岁跟骨骨折患者,共80例,分为治疗组40例和对照组40例,通过对年龄、性别、患侧、骨折愈合时间、骨折类型进行比较,采用国际通用AOFAS(美国骨科学会足踝协会)踝后足评分标准进行评分对比。治疗组采用合拢下拉法治疗,对照组采用切开复位内固定治疗。分析比较两组骨折患者自述症状,足跟形态变化,X线侧位,轴位片变化,并做统计学处理。
结果:临床研究显示,治疗组:显效30例,占75.0%,有效6例,占15.0%,总有效率为90.0%。对照组:显效12例,占30.0%,有效18例,占45.0%,总有效率75.0%,治疗组总有效率明显优于对照组总有效率,经统计学分析,两组之间有明显差异(P≤0.01)。
结论:合拢下拉法较切开复位内固定治疗跟骨骨折临床疗效好,且安全简便,可靠实用。两组对比治疗组明显优于对照组,值得临床推广应用。
Objective: To shut down the clinical treatment of calcaneal fractures to close down law to explore and study the clinical efficacy of calcaneal fractures, calcaneal fractures to provide strong clinical research and theoretical value.
Methods: From October 2009 to April 2011 Haicheng and Traumatology Hospital in-patients aged 18 to 65 patients with fractures, a total of 80 patients, 40 patients were divided into treatment group and control group of 40 patients, by age, gender, injury side of the fracture healing time, type of fracture were compared, using internationally accepted standards AOFAS ankle hindfoot score rate comparison. The treatment group was closed down treatment in the control group treated with open reduction and internal fixation. Analysis of fracture patients were compared readme symptoms, morphological changes of the heel, X ray lateral, axial film changes, and to do statistical analysis.
Results: The clinical study showed that the treatment group: 30 cases markedly, accounting for 75.0%, effective in 6 cases, 15.0%, total effective rate was 90.0%. Control group: 12 cases markedly, accounting for 30.0%, effective in 18 cases, 45.0%, total effective rate was 75.0% , the efficiency of the treatment group was significantly better than the control group, the total efficiency of the statistical analysis, significantly between the two groups differences (P≤0.01).
Conclusion: Closure of the drop-down method is better than open reduction and internal fixation of calcaneal fractures is effective, safe and convenient, reliable and practical. The treatment group compared the two groups than the control group, worthy of clinical application.
引文
[1]陈建良,张龙君.跟骨关节内骨折的分类和治疗进展[J].中国骨伤, 2007, 20(2): 139.
[2] RammeltS,ZwippH. Calcaneus fractures:facts,controversies and re-centdevelopments[J]. Injury,2004,35(5):443-461.
[3]秦忠延.闭合手法复位经皮穿针内固定术治疗跟骨骨折[J].光明中医.2008,2(23)2:190-191.
[4]袁福禄,许俊岭,石国军,李晓明,王红玉,韩广普,张洪相.中西医结合微创治疗关节内跟骨骨折[J].河北医药.2006,4(28)4:315-316
[5]邓磊,肖京,刘沂.跟骨骨折治疗方法的探讨[J].骨与关节损伤杂志,2004,19(1):25-27.
[6]陈红卫,赵钢生,鲍丰等.移位跟骨关节内骨折的手术治疗[J].骨与关节损伤杂志,2004,19(1):59-60.
[7]杨俊峰,蔡建平,崔丙军.AO跟骨解剖钢板治疗跟骨关节内骨折的疗效分析[J].长春中医药大学学报.2007,10(23)5:49-50.
[8]梅炯,俞光荣,朱辉等.SandersⅣ型跟骨骨折的手术治疗[J].中华外科杂志,2001,39(2):106-108.
[9]胡机愉,周海平,冯健等.手术治疗跟骨关节内移位骨折[J].中国骨伤,2001,14(12):724~726.
[10]荣国威,翟桂华,刘沂等.骨科内固定(第3版) [M].北京:人民卫生出版社,1995.426.
[11]杜景文,张建新.跟骨骨折的治疗研究新进展[J].内蒙古中医药,2007,10(10):54-55.
[12] Eastwood DM,Gregg PJ,Atkins RM.Intraarticular fracture of the calcaneum, part I: pathological anatomy and classification[J]. Bone Joint Surg(Br),1993,75:183.
[13] Brudeaux BD.The medical approach for calcaneal fractures[J].Clin Orthop,1993,209:96.
[14] Johnson EE,Gebhardt JS.Surgical management of calcanea fractures:using bilateral incisions and minimal internal fixation[J].Clin Orthop,1993,290:117.
[15] Stephenson JR,Surgical treatment of displaced intraarticula fracture of the calcaneus:a combined lateral and medical ap-proach[J].Clin Orthop,1993,290:68.
[16]郑常青,曾荇,周友华.切开复位Y型钢板内固定治疗跟骨关节内骨折[J].中国骨与关节损伤杂志.2007,10(22)10:848-849
[17]李林,戴世友,李成福等.AO跟骨钢板在III、IV型跟骨骨折的临床应用[J].中华创伤骨科杂志,2005,7(1):48-51.
[18]刘建国,李贵斌,陈洪瑜等.跟骨关节内骨折的治疗[J].中国骨与关节损伤杂志,2005,20(9):608-610.
[19] Geel CW,Flemister ASJ.Standardized treatment of intraarticularcalcanel fractures using an oblique lateral incision and no bone graft.J Trauma,2001,50: 1083-1089.
[20] Aldridge JM 3rd,Easley M,Nunley JA.Open calcaneal fractures: results of operative treatment.J Orthop Trauma,2004,18:7-11.
[21]黄伟松,郑荣生,陈峰,杨立国.AO跟骨钛板固定治疗累及跟距关节的跟骨骨折24例[J].福建医药杂志.2007,29(6):67-68.
[22] Siebert CH,Hansen M,Wolter D.Follow-up evaluation of open intra-articular fractures of the calcaneus.Arch Orthop Trauma Surg,1998,117:442-447.
[23]蔡锦方,李秉胜,曹学成,梁进.足跟再造术长期疗效观察[J].中华外科杂志,2001,39:869-871.
[24] Schwartsman V,Schwartsman R.Reduction techniques with the Ilizarov frame for calcaneal fractures[J].Tech Orthop,2002,17:185-196.
[25] McGarvey WC,Burris MW.Calcaneal fractures:indirect reduction and external fixation[J].Tech Foot Ankle Surg,2004,3:258-268.
[26]高质钢,张浩,薛静,等.U形外固定架结合闭合手法复位治疗跟骨骨折[J].中华骨科杂志,2004,24:19-21.
[27] Leonard M, George R, Sergei Y. Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing[J].J Foot Ankle Surg, 2004,43(1):43-50.
[28] Clare MP.Open reduction and intemal fixation with primary subatalar arthrodesis for sanders typeⅣcalcaneus fractures[J].Tech Foot Ankle Surg,2004,(3):250-257.
[29]王亦璁.骨与关节损伤〔M〕.第3版.北京:人民卫生出版社,2001:1140.
[30] Peng-Ju Huang, Hsuan-Ti Huang, Tai-Bin Chen,et al. Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus[J]. J Trauma, 2002,52:946.
[31] Gavlik JM,Rammelt S,Zwipp H.Percutaneous,arthroscopically assisted osteosynthesis of calcaneus fractures[J]. Arch Orthop Trauma Surg, 2002,122(8):424-428.
[32] Rammelt S,Gavlik JM,Barthel S,et al. The value of subtalar arthroscopy in themanagement of intraarticular calcaneus fractures[J]. Foot Ankle Int, 2002,23(10): 906-916.
[33] Johann M, Gavlik JM,Rammelt S,et al. The use of subtalar arthroscipy in open reduction and internal fixation of intraarticular calcaneal fractures[J]. Injury, Int. J care Injured, 2002,33:63-71.
[34] Rammelt S, Amlang M, Barthel S, et al.Minimallyinvasive treatment of calcaneal fractures[J]. Injury, Int, J Care Injured,2004,35:55-63.
[35]刘平.手法复位配合中药治疗跟骨骨折32例[J].现代医药卫生.2005, 21(23):3278-3279.
[36]钱承美,王文柏.中药熏洗合手法复位治疗距下关节内跟骨骨折82例[J].辽宁中医药大学报.2007,11(9)6:152-153.
[37]陈斌,曹日隆,刘安平.中医辨证治疗围手术期跟骨骨折16例[J].安徽中医学院学报.2007,2(26)1:14-15.
[38] Sanders R.Current concept review:DisPlaced intraarticular fractures of the calcaneus[J]. JBJS,2000,82-A:225-250.
[39] SandersR,FortinP,DIPasqualeT,WallingA.Operative treatment in 120 disPlaeed intraartieular caleaneal fraetures.Results using a prognostic computed tomography scan classifieation[J].ClinOrthoP,1993,(290):87-95.
[40] KerrPS,Prothero DL,Atkins RM.Assessing outeome following caleaneal fracture[J]. arationalscoring system.Injury,1996,27:35-38.
[41] KitaokaHB,Alexander IJ,Adelaor RS,Nunley JA,Myerson MS,Sanders M.Clinical rating system for ankle-hindfoot,midfoot.and lesser toes.Foot Ankle Int,1994.15: 349-353.
[42]窦榆生,廖永华,师建军.跟骨骨折的CT分类和疗效评定进展[J].美中国际创伤杂志,2006;5(4):43-45.
[43]张英泽,宋朝晖,韩久卉等.智能机器人辅助治疗复杂性跟骨骨折[J].河北医科大学学报,2005,26(2):134-136.
[2] RammeltS,ZwippH. Calcaneus fractures:facts,controversies and re-centdevelopments[J]. Injury,2004,35(5):443-461.
[3]秦忠延.闭合手法复位经皮穿针内固定术治疗跟骨骨折[J].光明中医.2008,2(23)2:190-191.
[4]袁福禄,许俊岭,石国军,李晓明,王红玉,韩广普,张洪相.中西医结合微创治疗关节内跟骨骨折[J].河北医药.2006,4(28)4:315-316
[5]邓磊,肖京,刘沂.跟骨骨折治疗方法的探讨[J].骨与关节损伤杂志,2004,19(1):25-27.
[6]陈红卫,赵钢生,鲍丰等.移位跟骨关节内骨折的手术治疗[J].骨与关节损伤杂志,2004,19(1):59-60.
[7]杨俊峰,蔡建平,崔丙军.AO跟骨解剖钢板治疗跟骨关节内骨折的疗效分析[J].长春中医药大学学报.2007,10(23)5:49-50.
[8]梅炯,俞光荣,朱辉等.SandersⅣ型跟骨骨折的手术治疗[J].中华外科杂志,2001,39(2):106-108.
[9]胡机愉,周海平,冯健等.手术治疗跟骨关节内移位骨折[J].中国骨伤,2001,14(12):724~726.
[10]荣国威,翟桂华,刘沂等.骨科内固定(第3版) [M].北京:人民卫生出版社,1995.426.
[11]杜景文,张建新.跟骨骨折的治疗研究新进展[J].内蒙古中医药,2007,10(10):54-55.
[12] Eastwood DM,Gregg PJ,Atkins RM.Intraarticular fracture of the calcaneum, part I: pathological anatomy and classification[J]. Bone Joint Surg(Br),1993,75:183.
[13] Brudeaux BD.The medical approach for calcaneal fractures[J].Clin Orthop,1993,209:96.
[14] Johnson EE,Gebhardt JS.Surgical management of calcanea fractures:using bilateral incisions and minimal internal fixation[J].Clin Orthop,1993,290:117.
[15] Stephenson JR,Surgical treatment of displaced intraarticula fracture of the calcaneus:a combined lateral and medical ap-proach[J].Clin Orthop,1993,290:68.
[16]郑常青,曾荇,周友华.切开复位Y型钢板内固定治疗跟骨关节内骨折[J].中国骨与关节损伤杂志.2007,10(22)10:848-849
[17]李林,戴世友,李成福等.AO跟骨钢板在III、IV型跟骨骨折的临床应用[J].中华创伤骨科杂志,2005,7(1):48-51.
[18]刘建国,李贵斌,陈洪瑜等.跟骨关节内骨折的治疗[J].中国骨与关节损伤杂志,2005,20(9):608-610.
[19] Geel CW,Flemister ASJ.Standardized treatment of intraarticularcalcanel fractures using an oblique lateral incision and no bone graft.J Trauma,2001,50: 1083-1089.
[20] Aldridge JM 3rd,Easley M,Nunley JA.Open calcaneal fractures: results of operative treatment.J Orthop Trauma,2004,18:7-11.
[21]黄伟松,郑荣生,陈峰,杨立国.AO跟骨钛板固定治疗累及跟距关节的跟骨骨折24例[J].福建医药杂志.2007,29(6):67-68.
[22] Siebert CH,Hansen M,Wolter D.Follow-up evaluation of open intra-articular fractures of the calcaneus.Arch Orthop Trauma Surg,1998,117:442-447.
[23]蔡锦方,李秉胜,曹学成,梁进.足跟再造术长期疗效观察[J].中华外科杂志,2001,39:869-871.
[24] Schwartsman V,Schwartsman R.Reduction techniques with the Ilizarov frame for calcaneal fractures[J].Tech Orthop,2002,17:185-196.
[25] McGarvey WC,Burris MW.Calcaneal fractures:indirect reduction and external fixation[J].Tech Foot Ankle Surg,2004,3:258-268.
[26]高质钢,张浩,薛静,等.U形外固定架结合闭合手法复位治疗跟骨骨折[J].中华骨科杂志,2004,24:19-21.
[27] Leonard M, George R, Sergei Y. Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing[J].J Foot Ankle Surg, 2004,43(1):43-50.
[28] Clare MP.Open reduction and intemal fixation with primary subatalar arthrodesis for sanders typeⅣcalcaneus fractures[J].Tech Foot Ankle Surg,2004,(3):250-257.
[29]王亦璁.骨与关节损伤〔M〕.第3版.北京:人民卫生出版社,2001:1140.
[30] Peng-Ju Huang, Hsuan-Ti Huang, Tai-Bin Chen,et al. Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus[J]. J Trauma, 2002,52:946.
[31] Gavlik JM,Rammelt S,Zwipp H.Percutaneous,arthroscopically assisted osteosynthesis of calcaneus fractures[J]. Arch Orthop Trauma Surg, 2002,122(8):424-428.
[32] Rammelt S,Gavlik JM,Barthel S,et al. The value of subtalar arthroscopy in themanagement of intraarticular calcaneus fractures[J]. Foot Ankle Int, 2002,23(10): 906-916.
[33] Johann M, Gavlik JM,Rammelt S,et al. The use of subtalar arthroscipy in open reduction and internal fixation of intraarticular calcaneal fractures[J]. Injury, Int. J care Injured, 2002,33:63-71.
[34] Rammelt S, Amlang M, Barthel S, et al.Minimallyinvasive treatment of calcaneal fractures[J]. Injury, Int, J Care Injured,2004,35:55-63.
[35]刘平.手法复位配合中药治疗跟骨骨折32例[J].现代医药卫生.2005, 21(23):3278-3279.
[36]钱承美,王文柏.中药熏洗合手法复位治疗距下关节内跟骨骨折82例[J].辽宁中医药大学报.2007,11(9)6:152-153.
[37]陈斌,曹日隆,刘安平.中医辨证治疗围手术期跟骨骨折16例[J].安徽中医学院学报.2007,2(26)1:14-15.
[38] Sanders R.Current concept review:DisPlaced intraarticular fractures of the calcaneus[J]. JBJS,2000,82-A:225-250.
[39] SandersR,FortinP,DIPasqualeT,WallingA.Operative treatment in 120 disPlaeed intraartieular caleaneal fraetures.Results using a prognostic computed tomography scan classifieation[J].ClinOrthoP,1993,(290):87-95.
[40] KerrPS,Prothero DL,Atkins RM.Assessing outeome following caleaneal fracture[J]. arationalscoring system.Injury,1996,27:35-38.
[41] KitaokaHB,Alexander IJ,Adelaor RS,Nunley JA,Myerson MS,Sanders M.Clinical rating system for ankle-hindfoot,midfoot.and lesser toes.Foot Ankle Int,1994.15: 349-353.
[42]窦榆生,廖永华,师建军.跟骨骨折的CT分类和疗效评定进展[J].美中国际创伤杂志,2006;5(4):43-45.
[43]张英泽,宋朝晖,韩久卉等.智能机器人辅助治疗复杂性跟骨骨折[J].河北医科大学学报,2005,26(2):134-136.