小切口微型钢板结合不同螺钉固定治疗跟骨粉碎性骨折的疗效观察
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摘要
目的:研究小切口微型钢板结合不同螺钉固定治疗跟骨粉碎性骨折的疗效。方法:选择本院2016年7月至2018年7月纳入的104例跟骨粉碎性骨折患者作为研究对象,按照随机数字表法分为两组(各52例),试验组采取跗骨窦小切口微型钢板拉力螺钉结合锁定螺钉固定,对照组采取相同切口全部锁定螺钉固定,对比两组治疗结果。结果:治疗前两组的跟骨高度、跟骨宽度相比无差异,治疗后试验组跟骨高度及宽度均优于对照组,差异有统计学意义(P<0.05)。试验组关节面平整效果的优良率90.38%,明显高于对照组78.85%,差异有统计学意义(P<0.05)。试验组并发症发生率5.77%,明显低于对照组17.31%,差异有统计学意义(P<0.05)。治疗前两组的疼痛视觉模拟评分(VAS)和美国矫形外科足踝协会足功能评分(AOFAS),差异无统计学意义(P>0.05),治疗后试验组各项评分均优于对照组,差异有统计学意义(P<0.05)。结论:小切口微型钢板拉力螺钉结合锁定螺钉固定运用于跟骨粉碎性骨折中效果明显,可有效改善跟骨高度及宽度,减少并发症产生,促进关节面平整,减轻疼痛,改善踝关节功能。
Objective:To study the clinical value of mini-incision mini-plate lag screw plus locking screw in comminuted fracture of heel bone.Methods:104 comminuted fracture of heel bone patients treated from July 2016 to July 2018 in our hospital were selected and randomly assigned to two groups,52 cases in each group.The study group took the mini-incision mini-plate lag screw plus locking screw;the control group just took the locking screw.The therapeutic effect was probed.Results: Before treatment,heel bone height and width between groups was not significantly different;after treatment,heel bone height and width in the study group was better than that of control group(P<0.05);the good rate of smooth articular surface in the study group(90.38%) was higher than that of control group(78.85%)(P<0.05);the complication rate in the study group(5.77%) was lower than that of control group(17.31%)(P<0.05);before treatment,VAS(visual analogue scale) and AOFAS(American orthopaedic foot & ankle society) scores between groups were not significantly different(P>0.05);after treatment,related scores in the study group were better than those of control group(P<0.05).Conclusion:The mini-incision mini-plate lag screw plus locking screw can greatly improve the heel bone height and width,reduce the complication rate,promote the smooth articular surface,relieve the pain and increase the ankle joint function.
Objective:To study the clinical value of mini-incision mini-plate lag screw plus locking screw in comminuted fracture of heel bone.Methods:104 comminuted fracture of heel bone patients treated from July 2016 to July 2018 in our hospital were selected and randomly assigned to two groups,52 cases in each group.The study group took the mini-incision mini-plate lag screw plus locking screw;the control group just took the locking screw.The therapeutic effect was probed.Results: Before treatment,heel bone height and width between groups was not significantly different;after treatment,heel bone height and width in the study group was better than that of control group(P<0.05);the good rate of smooth articular surface in the study group(90.38%) was higher than that of control group(78.85%)(P<0.05);the complication rate in the study group(5.77%) was lower than that of control group(17.31%)(P<0.05);before treatment,VAS(visual analogue scale) and AOFAS(American orthopaedic foot & ankle society) scores between groups were not significantly different(P>0.05);after treatment,related scores in the study group were better than those of control group(P<0.05).Conclusion:The mini-incision mini-plate lag screw plus locking screw can greatly improve the heel bone height and width,reduce the complication rate,promote the smooth articular surface,relieve the pain and increase the ankle joint function.
引文
[1] 肖凯,方真华,安颖,等.跗骨窦小切口及经皮复位固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折[J].中华骨科杂志,2018,38(15):905-912.
[2] PASTIDES P S,MILNES L,ROSENFELD P F.et al.Percutaneous arthroscopic calcaneal osteosynthesis:a minimally invasive technique for displaced intra-articular calcaneal fractures[J].J Foot Ankle Surg,2015,54(5):798-804.
[3] 马璐,曲爱丽,景捷,等.侧向拉力螺钉坚固内固定髁突矢状骨折愈合进程中的三维有限元分析[J].宁夏医科大学学报,2018,40(4):412-417.
[4] ECKARDT H,LIND M.Effect of intraoperative three-dimensional imaging during the reduction and fixation of displaced calcaneal fractures on articular congruence and implant fixation[J].Foot and Ankle International,2015,36(7):764-773.
[5] BATTAGLIA A,CATANIA P,GUMINA S,et al.Early minimally invasive percutaneous fixation of displaced intra-articular calcaneal fractures with a percutaneous angle stable device[J].The Journal of Foot and Ankle Surgery,2015,54(1):51-56.
[6] GIJANJN I L,ABOUSAYED M,TOUSSAINI R J,et al.Calcaneal avulsion fractures:a case series of 33 patients describing prognostic factors and outcomes[J].Foot Ankle Specialist,2015,8(1):10-17.
[7] 刘耀辉,李雪林,陈小微,等.跗骨窦小切口结合空心螺钉与L型切口结合钢板内固定治疗SandersⅢ型跟骨骨折疗效比较[J].世界复合医学,2017,3(4):9-12.
[8] 刘智华,方兵,袁展程,等.小切口入路治疗跟骨骨折[J].临床骨科杂志,2016,19(4):487-488.
[9] CHEN X D,ZHANG C C,LI Z C,et al.Clinical analysis of internal fixation treatment of intra-articular calcaneal fractures with titanium plate[J].Cell Biochemistry and Biophysics,2015,72(1):153-156.
[10] 孙绍裘,张杰,董克芳,等.手法复位三角形固定器治疗跟骨关节内骨折的临床研究[J].中国中医骨伤科杂志,2003,11(6):19-21.
[11] 黄宁,史景超,蒋海勇,等.跟距关节面外侧缘微创小切口结合可吸收螺钉内固定治疗SandersⅡ～Ⅲ型跟骨骨折[J].浙江创伤外科,2015,20(4):683-684.
[12] KINNER B,KERSCHBAUM M,BLEY C,et al.Bionic plate design for calcaneal fracture treatment:a biomechanical analysis and first clinical results[J].International Orthopaedics,2015,39(1):111-117.
[13] 陈明,邓葵,曾晚辉,等.微创跗骨窦小切口手法复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华外科杂志,2017,55(3):220-223.
[14] 马勇,方永刚,孙文健,等.跟骨异形钢板治疗跟骨关节内骨折[J].中国中医骨伤科杂志,2006,14(5):47-48.
[15] WANG Q,LI X,SUN Y,et al.Comparison of the outcomes of two operational methods used for the fixation of calcaneal fracture[J].Cell Biochemistry and Biophysics,2015,72(1):191-196.
[16] 张惠法,王培民,魏成建,等.医源性因素对跟骨钢板治疗跟骨关节内骨折疗效的影响[J].中国中医骨伤科杂志,2005,13(6):47-48.
[17] AGREN P H,TULLBERG T,MUKKA S,et al.Post-traumatic in situ fusion after calcaneal fractures:A retrospective study with 7-28 years follow-up[J].Foot and Ankle Surgery,2015,21(1):56-59.
[18] MAXWELL A B,OWEN J R,GILBERT T M,et al.Biomechanical performance of lateral versus dual locking plates for calcaneal fractures[J].The Journal of Foot and Ankle Surgery,2015,54(5):830-835.
[2] PASTIDES P S,MILNES L,ROSENFELD P F.et al.Percutaneous arthroscopic calcaneal osteosynthesis:a minimally invasive technique for displaced intra-articular calcaneal fractures[J].J Foot Ankle Surg,2015,54(5):798-804.
[3] 马璐,曲爱丽,景捷,等.侧向拉力螺钉坚固内固定髁突矢状骨折愈合进程中的三维有限元分析[J].宁夏医科大学学报,2018,40(4):412-417.
[4] ECKARDT H,LIND M.Effect of intraoperative three-dimensional imaging during the reduction and fixation of displaced calcaneal fractures on articular congruence and implant fixation[J].Foot and Ankle International,2015,36(7):764-773.
[5] BATTAGLIA A,CATANIA P,GUMINA S,et al.Early minimally invasive percutaneous fixation of displaced intra-articular calcaneal fractures with a percutaneous angle stable device[J].The Journal of Foot and Ankle Surgery,2015,54(1):51-56.
[6] GIJANJN I L,ABOUSAYED M,TOUSSAINI R J,et al.Calcaneal avulsion fractures:a case series of 33 patients describing prognostic factors and outcomes[J].Foot Ankle Specialist,2015,8(1):10-17.
[7] 刘耀辉,李雪林,陈小微,等.跗骨窦小切口结合空心螺钉与L型切口结合钢板内固定治疗SandersⅢ型跟骨骨折疗效比较[J].世界复合医学,2017,3(4):9-12.
[8] 刘智华,方兵,袁展程,等.小切口入路治疗跟骨骨折[J].临床骨科杂志,2016,19(4):487-488.
[9] CHEN X D,ZHANG C C,LI Z C,et al.Clinical analysis of internal fixation treatment of intra-articular calcaneal fractures with titanium plate[J].Cell Biochemistry and Biophysics,2015,72(1):153-156.
[10] 孙绍裘,张杰,董克芳,等.手法复位三角形固定器治疗跟骨关节内骨折的临床研究[J].中国中医骨伤科杂志,2003,11(6):19-21.
[11] 黄宁,史景超,蒋海勇,等.跟距关节面外侧缘微创小切口结合可吸收螺钉内固定治疗SandersⅡ～Ⅲ型跟骨骨折[J].浙江创伤外科,2015,20(4):683-684.
[12] KINNER B,KERSCHBAUM M,BLEY C,et al.Bionic plate design for calcaneal fracture treatment:a biomechanical analysis and first clinical results[J].International Orthopaedics,2015,39(1):111-117.
[13] 陈明,邓葵,曾晚辉,等.微创跗骨窦小切口手法复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华外科杂志,2017,55(3):220-223.
[14] 马勇,方永刚,孙文健,等.跟骨异形钢板治疗跟骨关节内骨折[J].中国中医骨伤科杂志,2006,14(5):47-48.
[15] WANG Q,LI X,SUN Y,et al.Comparison of the outcomes of two operational methods used for the fixation of calcaneal fracture[J].Cell Biochemistry and Biophysics,2015,72(1):191-196.
[16] 张惠法,王培民,魏成建,等.医源性因素对跟骨钢板治疗跟骨关节内骨折疗效的影响[J].中国中医骨伤科杂志,2005,13(6):47-48.
[17] AGREN P H,TULLBERG T,MUKKA S,et al.Post-traumatic in situ fusion after calcaneal fractures:A retrospective study with 7-28 years follow-up[J].Foot and Ankle Surgery,2015,21(1):56-59.
[18] MAXWELL A B,OWEN J R,GILBERT T M,et al.Biomechanical performance of lateral versus dual locking plates for calcaneal fractures[J].The Journal of Foot and Ankle Surgery,2015,54(5):830-835.