微创小切口钛板内固定治疗跟骨骨折  

Application of the lateral malleolus small incision and the anatomical plate internal fixation for the treatment of calcaneal fractures

作　　者：李伟[1] 张克民[1] 陈雪梅[2] 郭文玲[2] 马建林[3] 

机构地区：[1]滨州市中心医院骨关节外科,251700 [2]滨州市中心医院产科,251700 [3]滨州市中心医院急诊科,251700

出　　处：《中华损伤与修复杂志（电子版）》2012年第5期34-38,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的通过与传统"L"形切口结合跟骨解剖钛板内固定手术法比较,介绍外踝下小切口结合跟骨解剖钛板内固定手术方法在跟骨骨折治疗中的优势。方法回顾性分析2008年12月至2010年12月滨州市中心医院对所收治的33例35足跟骨关节内的骨折病例行随机分组,分为A组(17例17足)和B组(16例18足),分别采用外踝下小切口结合跟骨解剖钛板内固定并植骨和传统的跟骨外侧"L"形切口跟骨解剖钛板内固定并植骨的方法治疗,并以Bohler’s角、Gissane’s角、跟骨宽度、手术时间、切口并发症、拆线时间、Maryland评分等指标评价两种治疗方法的效果。结果 A组17足,术后无1例出现并发症,Maryland足部评分优l2足、良3足、可1足、差1足,优良率为88.23%。B组18足,术后5足出现皮缘的浅表坏死,2足出现皮肤部分坏死,4足出现足外侧缘皮肤麻木,Maryland足部评分优l0足、良5足、可2足、差1足,优良率为83.33%。A组切口并发症发生率为0,低于B组39%,差异具有统计学意义(P<0.05),A组手术时间(67±9)min短于B组(85±12)min,差异具有统计学意义(P<0.05),A组术后至拆线时间(14±1.3)d短于B组(17±2.4)d,差异具有统计学意义(P<0.05)。结论外踝下小切口结合跟骨解剖钛板内固定法治疗跟骨骨折,与常规"L"形切口相比较,对治疗跟骨骨折具有术后切口并发症少、手术时间短、术后恢复快的优势。Objective To compare the lateral malleolus small incision and the anatomical plate internal fixation treatment with the traditional L-type incision treatment, and illustrate the advantages of the new method. Methods Thirty-three cases （with 35 foot ） of intra-articular calcaneal fractures collected in the period of Dec. 2008 to Dec. 2010 were investigated and divided to two groups： A group （lateral malleolus small incision was used） and B group （L-type incision method was used）. Bohler angle, Gissane angle, the width of the calcaneus, the time of operation, wound complications, the time of stitches and Maryland foot score were adopted to evaluate the treatment effects of above two methods. Results No complication was observed in the 17 cases of group A, which were composed of 12 excellent cases, 3 good cases, 1 fair cases, and 1 bad cases according to Maryland foot score, and produced an excellent and good rate of 88.23%. In the 18 cases of group B, 5 cases of skin edges superficial necrosis, 2 cases of partial necrosis of skin, and 4 cases of lateral foot edge skin numbness were observed, which are composed of 10 excellent cases, 5 good cases, 2 fair cases, and 1 bad cases, and gave an excellent and good rate of83.33%. Furthermore, the average values of the complication rate, the operation time, and the stitches of time in group A were 0, （67 ± 9） min, and （4 ± 1.3 ） d, all of which displayed statistically significant difference （P〈0.05）, compared with that of 39%, （85 ± 12） min, and （17 ±2.4） d in group B. Conclusion Compared with the traditional L-type incision treatment, lateral malleolus small incision and the anatomical plate internal fixation treatment exhibited the characters of low complication rates, short operation time and quick recovery.

关 键 词：跟骨骨折 外踝下小切口 钛板内固定 对比研究 

分 类 号：R687.3[医药卫生—骨科学]