微创正骨术治疗跟骨骨折275例300足
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摘要
目的:探讨运用中医正骨手法及小切口克氏针撬拨复位法治疗跟骨骨折的临床疗效。方法:针对不同的骨折类型采用相应的闭合钳夹复位法、闭合钢针撬拨法、有限切开撬拨复位法对300足跟骨骨折患者进行治疗,参照Maryland跟骨骨折评价标准判定。结果:经钳夹复位小夹板固定法的142足,经皮撬拨闭合复位穿针内固定术的83足,有限切开撬拨复位内固定术的75足,随访6～12个月,平均8个月。所有患足术后无1例感染、皮肤坏死、神经损伤;复位部分丢失,结节关节角减少7足;3足严重距下关节痛,行距下关节融合术。根据Maryland跟骨骨折功能评价标准评分,优良率86%。结论:关节面骨折移位小于2 mm的SandersⅠ、Ⅱ型骨折,或患者身体状况不能耐受手术者应首选钳夹复位小夹板固定法治疗;移位的2部分跟骨关节外骨折、跟骨舌型骨折或跟骨粉碎骨折无法切开内固定者则应优先考虑闭合撬拨复位内固定术;跟骨关节内移位≥2mm的SandersⅡ、Ⅲ型骨折宜选用有限切开撬拨复位内固定术;同时在常规治疗和早期功能锻炼的基础上配合中药内服外敷能明显减轻术后疼痛,加快功能恢复。
Objective: to explore the clinical efficacy of traditional chinese medicine orthopedics and small incision Kirschner wire reduction in the treatment of calcaneal fractures. Methods: For the different fracture types, the patients with 300 heel fractures were treated with the corresponding closed clamp reduction method, closed steel needle splitting method and limited incision and reduction method. The evaluation was based on the evaluation criteria of Maryland calcaneal fracture. RESULTS: 142 feet were treated with clamp-reset small splint fixation, 83 feet with percutaneous transluminal closure and internal fixation, and 75 feet with limited incision and internal fixation were followed up for 6-12 months, averaged 8 months. there was no infection, skin necrosis or nerve damage in all patients after the operation; the partial loss was lost, the joint angle of the nodule was reduced in 7 feet; the 3 feet had severely subtalar joint pain, and the subtalar arthrodesis was performed. According to the Maryland calcaneus fracture functional evaluation criteria, the excellent and good rate was 86%. Conclusion: Sanders I and II fractures with articular surface fracture displacement less than 2 mm, or patients with unsatisfactory physical condition should be treated with clamp reduction and splint fixation; as for 2 parts of displaced extrahepatic fractures and calcaneal tongue, if the fracture of the calcaneus cannot be cut open, the closure and internal fixation should be given priority. the Sanders ii and iii fractures with ≥ 2 mm of the calcaneus joint should be treated with limited open reduction and internal fixation. at the same time, on the basis of conventional treatment and early functional exercise, combined with external application of traditional Chinese medicine could significantly reduce postoperative pain and accelerate functional recovery.
Objective: to explore the clinical efficacy of traditional chinese medicine orthopedics and small incision Kirschner wire reduction in the treatment of calcaneal fractures. Methods: For the different fracture types, the patients with 300 heel fractures were treated with the corresponding closed clamp reduction method, closed steel needle splitting method and limited incision and reduction method. The evaluation was based on the evaluation criteria of Maryland calcaneal fracture. RESULTS: 142 feet were treated with clamp-reset small splint fixation, 83 feet with percutaneous transluminal closure and internal fixation, and 75 feet with limited incision and internal fixation were followed up for 6-12 months, averaged 8 months. there was no infection, skin necrosis or nerve damage in all patients after the operation; the partial loss was lost, the joint angle of the nodule was reduced in 7 feet; the 3 feet had severely subtalar joint pain, and the subtalar arthrodesis was performed. According to the Maryland calcaneus fracture functional evaluation criteria, the excellent and good rate was 86%. Conclusion: Sanders I and II fractures with articular surface fracture displacement less than 2 mm, or patients with unsatisfactory physical condition should be treated with clamp reduction and splint fixation; as for 2 parts of displaced extrahepatic fractures and calcaneal tongue, if the fracture of the calcaneus cannot be cut open, the closure and internal fixation should be given priority. the Sanders ii and iii fractures with ≥ 2 mm of the calcaneus joint should be treated with limited open reduction and internal fixation. at the same time, on the basis of conventional treatment and early functional exercise, combined with external application of traditional Chinese medicine could significantly reduce postoperative pain and accelerate functional recovery.
引文
[1]魏志勇,李铭雄.经皮夹挤结合撬拨复位空心钉固定治疗跟骨骨折[J].中医临床研究,2015,7(05):120-122.
[2]Baliga S,Sutherl A,Bruce J.Surgical versus conservative interventions for displaced intra-articular calcaneal fractures[J].Cochrane Database of Systematic Reviews,2013,1(01):53-54.
[3]Heller B,Sundermann B,Buschmann H,et al.Calcaneal fractures:update on current treatments.[J].Clinics in Podiatric Medicine&Surgery,2012,29(02):205-220.
[4]郭维淮.洛阳平乐正骨[M].4版.北京:人民卫生出版社,2008:479.
[5]苏宏伟.闭合撬拨复位内固定与切开复位内固定治疗SandersⅡ-Ⅲ型跟骨骨折的疗效对比[D].长春:吉林大学,2016.
[6]Zheng Y B,Qi Y F.Research progress in the treatment of calcaneal fractures[J].Zhongguo Gu Shang,2012,25(11):962-966.
[7]Guerado E,Bertrand M L,Cano J R.Management of calcaneal fractures:what have we learntover the years?[J].Injury,2012,43(10):1640-1650.
[8]Wu Z,Su Y,Chen W,et al.Functional outcome of displaced intraarticular calcaneal fractures:acomparison between open reduction/internal fixation and a minimally invasive approach featured ananatomical plate and compression bolts[J].J Trauma Acute Care Surg,2012,73(03):743-751.
[9]Harnroongroj T,Chuckpaiwong B,Angthong C,et al.Displaced articular calcaneus fractures:classification and fracture scores:a preliminary study[J].J Med Assoc Thai,2012,95(03):366-377.
[10]吕金柱,张桂华,唐晓强.小切口结合有限内固定在治疗跟骨骨折中防止皮瓣感染或坏死的体会[J].中国骨与关节损伤杂志,2012,27(12):1144-1145.
[11]顾怀增,文明,曾超.外侧小切口有限内固定治疗关节内跟骨骨折[J].潍坊医学院学报,2016,38(03):209-211.
[12]杨士勇,张启恩,马进,等.两种手术方式结合中医药治疗跟骨骨折的临床观察[J].中医临床研究,2017,09(13):14-16.
[2]Baliga S,Sutherl A,Bruce J.Surgical versus conservative interventions for displaced intra-articular calcaneal fractures[J].Cochrane Database of Systematic Reviews,2013,1(01):53-54.
[3]Heller B,Sundermann B,Buschmann H,et al.Calcaneal fractures:update on current treatments.[J].Clinics in Podiatric Medicine&Surgery,2012,29(02):205-220.
[4]郭维淮.洛阳平乐正骨[M].4版.北京:人民卫生出版社,2008:479.
[5]苏宏伟.闭合撬拨复位内固定与切开复位内固定治疗SandersⅡ-Ⅲ型跟骨骨折的疗效对比[D].长春:吉林大学,2016.
[6]Zheng Y B,Qi Y F.Research progress in the treatment of calcaneal fractures[J].Zhongguo Gu Shang,2012,25(11):962-966.
[7]Guerado E,Bertrand M L,Cano J R.Management of calcaneal fractures:what have we learntover the years?[J].Injury,2012,43(10):1640-1650.
[8]Wu Z,Su Y,Chen W,et al.Functional outcome of displaced intraarticular calcaneal fractures:acomparison between open reduction/internal fixation and a minimally invasive approach featured ananatomical plate and compression bolts[J].J Trauma Acute Care Surg,2012,73(03):743-751.
[9]Harnroongroj T,Chuckpaiwong B,Angthong C,et al.Displaced articular calcaneus fractures:classification and fracture scores:a preliminary study[J].J Med Assoc Thai,2012,95(03):366-377.
[10]吕金柱,张桂华,唐晓强.小切口结合有限内固定在治疗跟骨骨折中防止皮瓣感染或坏死的体会[J].中国骨与关节损伤杂志,2012,27(12):1144-1145.
[11]顾怀增,文明,曾超.外侧小切口有限内固定治疗关节内跟骨骨折[J].潍坊医学院学报,2016,38(03):209-211.
[12]杨士勇,张启恩,马进,等.两种手术方式结合中医药治疗跟骨骨折的临床观察[J].中医临床研究,2017,09(13):14-16.