小切口微型锁定钢板内固定结合中药治疗跟骨关节内骨折的临床研究  

Clinical Studies of Small Incision Mini Locking Fixation Combined with Traditional Chinese Medicine in Treatment of Intra-Articular Calcaneal Fractures

作　　者：祝海炳[1] 李哲明[1] 施忠民[2] 王庆丰[1] 沈军[1] 梅国华[2] 武理国[1] 

机构地区：[1]舟山市中医骨伤联合医院骨科,浙江舟山316000 [2]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华中医药学刊》2014年第5期1148-1150,共3页Chinese Archives of Traditional Chinese Medicine

基　　金：舟山市科技局项目(2013C31068)

摘　　要：目的：总结和评价采用跗骨窦入路小切口锁定钢板结合中药治疗跟骨关节内骨折的临床疗效。方法：选取2011年6月_2012年10月期间收治跟骨关节内骨折患者23例，术前常规行跟骨摄片及三维CT扫描确定骨折类型及关节面受累及情况，于伤后2—5天，平均（3±1．2）天行小切口钢板内固定，术后分期给予中药口服，术后随访并按美国足踝外科协会（AOFAS）评分标准综合评价患者的疗效。结果：本组全部病例术后获得6—12个月（平均10±2．6个月）的随访，切口均Ⅰ／甲愈合，无感染和皮肤坏死及内固定失败病例等发生。术后末次随访时跟骨Bohler角，Gissane角及跟骨宽度较术前明显改善，差异具有统计学意义（P〈0．05）。临床疗效为优17足、良5足、可1足、差0足，优良率达95％。结论：经跗骨窦入路小切口微型锁定钢板结合中药治疗跟骨关节内骨折能获得满意的临床疗效，且具有创伤小，软组织并发症少的优点，是一种安全可靠的技术，值得推广。Objective ： To summarize and evaluate the clinical curative effect of small incision mini locking fixation com- bined with traditional Chinese medicine in the treatment of intra- articular caleaneal fractures. Methods ：23 patients with intra - articular ealcaneal fracture in our hospital from June 2011 to October 2012 were selected and all pre - operative ca- ses were evaluated the ealcaneal radiography and three - dimensional CT scan was used to determine the fracture types and articular surface involvement. After the injury to 2 - 5 days （ mean 3 _＋ 1.2 days ） , small incision and plate fixation were used, staging to give oral medicine after operation. Postoperative follow - up and the United States of America Ankle Surgery Association （AOFAS） score standard of comprehensive evaluation of patients were used. Results： All cases were followed up for 6 -12 months （mean 10 2.6 months）. The incision healing was I/A,no infection and necrosis of skin and internal fixation failure cases. The last followed - up after operation of calcaneal Btihler angle, Gissane angle and cal- eaneal width was significantly better than that before operation and the difference was statistically significant（ P 〈 0.05 ）. Clinical efficacy was excellent in 17 feet, good in 5 feet, effective in 1 foot, difference in 0 feet and the excellent rate was 95%. Conclusion： Open reduction and locking plate fixation with percutaneous screws via a limited tarsal sinus incision combined with traditional Chinese medicine is a safe and reliable treatment for intra - articular calcaneal fracture, because it has the advantages of direct reduction of the articular surface, solid fixation, and limited soft tissue complication.

关 键 词：跟骨关节内骨折 小切口 锁定钢板 中药 

分 类 号：R683.42[医药卫生—骨科学]