摘要
目的比较撬拨复位与切开复位内固定治疗SandersⅡ型跟骨骨折的临床疗效。方法回顾分析2007年5月-2012年5月符合选择标准的122例SandersⅡ型跟骨骨折患者临床资料，根据固定方法不同将患者分为闭合组（采用经皮撬拨复位克氏针内固定，61例）和切开组（采用切开复位钢板内固定，6l例）。两组患者性别、年龄、侧别、体重、身高、身体质量指数、致伤原因、骨折分型、Bohler角、Gissane角及伤后至手术时间等一般资料比较差异均无统计学意义（P〉0．05），具有可比性。比较两组患者手术时间、术中出血量、住院天数、切口并发症、骨折愈合时间、临床功能（美国矫形足踝协会（AOFAS）评分）及术后影像学结果。结果闭合组手术时间、术中出血量及住院天数均显著少于切开组（P〈0．05）。两组均无深部感染，但切口组发生切口裂开3例、皮缘坏死2例及切口感染l例，闭合组未发生切口并发症，两组并发症发生率比较差异有统计学意义（P=0．027）。两组患者均获随访，闭合组随访时间24～68个月，平均38．7个月；开放组随访时间26～66个月，平均38-7个月。两组骨折愈合时间比较差异无统计学意义（t=-1．562，P=0．121）。末次随访时，闭合组和切开组患者术后Bohler角（t=-27．929，P=0．000；t=-32．565，P=0．000）和Gissane角（t=-26．351，P=0．000；t=-25．561，P=0．000）均较术前明显改善；术后两组间比较差异均无统计学意义（P〉0．05）。两组患者AOFAS评分比较差异无统计学意义（t=-0．492，P=0．624）。结论对于Sanders Ⅱ型跟骨骨折，采用经皮撬拨复位克氏针内固定与切开复位钢板内固定治疗均可获得满意临床疗效，但前者具有创伤较小、住院天数较短、切口并发症较少等优点。
Objective To compare the clinical results between percutaneous poking reduction fixation and open reduction and internal fixation for the displaced Sanders II type calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 122 patients with Sanders II type calcaneal fractures between May 2007 and May 2012, who accorded with the inclusion criteria. The closed reduction and percutaneus Kirschner wire fixation were used in 61 patients （dosed group）, and open reduction and internal fixation were used in 61 patients （open group）. There was no significant difference in gender, age, fracture side, weight, height, body mass index, the causes of injury, the fracture type, Bohler angle, Gissane angle, and the time from trauma to operation between 2 groups （P〉0.05）. The operation time, intraoperative blood loss, hospitalization days, wound complications, fracture healing time, American Orthopaedic Foot and Ankle Society （AOFAS） score, and radiographic results were compared between 2 groups. Results The operation time, intraoperative blood loss, and hospitalization days in closed group were significantly less than those in open group （P〈0.05）. There was no deep infections in both group; wound dehiscence, skin flap necrosis, and wound infection occurred in 3 patients, 2 patients, and 1 patient of the open group, no wound complication happened in closed group, and there was significant difference in the incidence of wound complications between 2 groups （P=0.027）. The patients were followed up 24-68 months （mean, 38.7 months） in the closed group and 26-66 months （mean, 38.7 months） in the open group. There was no significant difference in the fracture healing time between 2 groups （t= -1.562, P=0.121）. The Bohler angle and Gissane angle at last follow-up were significantly improved when compared with preoperative angle in the closed group （t= -27.929, P=0.000; t= -26.351, P=0.000） and the open group （ t= -32.565, P=0.000; t= -25.561, P=0.000）, but there was no significant difference between 2 groups （P〉0.05）. AOFAS score showed no significant difference between 2 groups （t= -0.492, P=0.624）. Conclusion For the displaced Sanders II type calcaneal fractures, the use of closed reduction and percutaneus Kirschner wire fixation or open reduction and internal fixation can both obtain satisfactory clinical function and radiographic results, but the former has the advantage of less trauma, shorter hospitalization time, and fewer wound complications.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第5期558-562,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
跟骨骨折
微创
经皮撬拨复位
切开复位
内固定
Calcaneal fracture
Minimal invasion
Percutaneous poking reduction
Open reduction
Internal fixation
