闭合复位经皮穿针内固定与切开复位接骨板内固定治疗PaleyB1型跟骨骨折的对比研究  

A retrospective trial of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures

作　　者：谭新欢 聂伟志[1] 隋显玉[1] 朱育林[1] 于兰先[1] 

机构地区：[1]山东省文登整骨医院,山东文登264400

出　　处：《中医正骨》2015年第12期16-19,23,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：山东省科技发展计划项目(2011YD19004);威海市科技发展计划项目(2015FZA03006);2014年国家中医药管理局全国名老中医药专家传承工作室建设项目

摘　　要：目的：比较闭合复位经皮穿针内固定与切开复位接骨板内固定治疗Paley B1型跟骨骨折的临床疗效和安全性。方法：回顾性分析2011年2月至2014年4月收治的120例Paley B1型跟骨骨折患者的病例资料,60例采用闭合复位经皮穿针内固定治疗（经皮穿针组）,其余60例采用切开复位接骨板内固定治疗（接骨板组）。比较2组患者的手术时间、住院时间、住院费用、Bhler角、Gissane角、并发症及临床疗效。结果：120例患者均获随访,随访时间53~66周,中位数57.5周。所有患者骨折均达到解剖复位或接近解剖复位。经皮穿针组的手术时间、住院时间及住院费用均低于接骨板组[（32.24±6.57）min,（67.57±9.32）min,t=15.324,P=0.000;（7.45±1.32）d,（21.50±2.63）d,t=8.459,P=0.000;（5213.42±743.89）元,（12 392.87±1984.32）元,t=18.996,P=0.000]。手术前后不同时间Bhler角的差异有统计学意义,即存在时间效应（F=5.957,P=0.039）;2组Bhler角比较,总体上差异无统计学意义,不存在分组效应（t=4.605,P=0.053）;术前、术后1 d、术后3个月、术后1年,2组Bhler角比较组间差异均无统计学意义[（16.56°±4.62°）,（17.10°±5.01°）,t=5.167,P=0.697;（33.49°±3.28°）,（33.38°±3.24°）,t=2.891,P=0.419;（32.78°±2.64°）,（32.94°±3.17°）,t=3.007,P=0.694;（32.54°±3.76°）,（32.89°±3.58°）,t=3.835,P=0.091];时间因素与分组因素不存在交互效应（F=5.585,P=0.176）。手术前后不同时间Gissane角的差异有统计学意义,即存在时间效应（F=4.598,P=0.036）;2组Gissane角比较,总体上差异无统计学意义,不存在分组效应（t=3.519,P=0.067）;术前、术后1 d、术后3个月、术后1年,2组Gissane角比较组间差异均无统计学意义[（82.74°±12.10°）,（82.44°±12.34°）,t=6.583,P=0.761;（132.48°±5.38°）,（132.59°±5.53°）,t=3.597,P=0.833;（132.83°±5.41°）,（131.97°±5.55°）,t=3.654,P=0.657;（131.57°±5.61°Objective：To compare the clinical curative effects and safety of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures. Methods： The medical records of 120 patients with Paley type B1 caleaneal fracture from February 2011 to April 2014 were analyzed retrospectively. Sixty patients（ percutaneous wire group）were treated with closed reduction and percutaneous internal fixation with Kirschner wire ,while the others（bone plate group）were treated with open reduction and internal fixation with bone plate. The operative time,hospital stays, cost of hospitalization, B6hler angle, Gissane angle, postoperative complications and clinical curative effects were compared between the 2 groups. Results ： All patients in the 2 groups were followed up for 53 - 66 weeks with a median of 57.5 weeks, and all fractures reached anatomical reduetion or nearly anatomical reduction. The operative time, hospital stays and cost of hospitalization were less in percutaneous wire groupcompared to bone plate group （32.24 ＋/- 6.57 vs 67.57 ＋/- 9.32 min, t = 15. 324, P = 0. 000 ;7.45 ＋/- 1.32 vs 21.50 ＋/- 2.63 days, t = 8. 459,P = 0. 000 ;5213.42 ＋/-743.89 vs 12392.87 ＋/- 1984.32 RMB, t = 18. 996, P = 0. 000）. There was statistical difference in the Bohler angle between different timepoints,in other words, there was time effect（ F = 5. 957 ,P = 0. 039）. In general, there was no statistical difference in the Bobler angle between the 2 groups, in other words, there was no group effect （ t = 4. 605, P = 0. 053 ）. There was no statisti- cal difference in the Bohler angle between the 2 groups before the operation and at 1 day, 3 months and 1 year after the operation （ 16.56 ＋/- 4.62 vs 17.10 ＋/- 5.01 degrees, t =5. 167, P = 0. 697 ; 33.49 ＋/- 3.28 vs 33.38 ＋/- 3.24 degrees, t = 2. 891, P = 0.419 ; 32.78 ＋/- 2.64 vs 32.94 ＋/- 3.17 degrees, t = 3. 007, P = 0. 694 ; 32.54 �

关 键 词：跟骨 骨折 闭合性 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]