切开复位钢板螺钉结合克氏针置入内固定对粉碎性跟骨关节内移位骨折伴后上方骨折患者GISSANE角、BOHLER角及MARYLAND足部评分的影响  

The effects of open reduction and internal fixation with plate screw combined with kirschner wire on the GISSANE angle,BOHLER angle and MARYLAND score in patients with comminuted calcaneal intra-articular and posterosuperior fractures

作　　者：彭义[1] 

机构地区：[1]唐山市第二医院足踝外科,河北唐山063000

出　　处：《临床和实验医学杂志》2017年第5期492-495,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的分析切开复位钢板螺钉结合克氏针置入内固定对粉碎性跟骨关节内移位骨折伴后上方骨折患者GISSANE角、BOHLER角及MARYLAND足部评分的影响。方法选取2014~2016年60例粉碎性跟骨关节内移位骨折伴后上方骨折患者,分为30例对照组行切开复位钢板螺钉固定,30例治疗组行切开复位钢板螺钉结合克氏针置入内固定。分别在术前和术后1个月测量所有患者的GISSANE角和BOHLER角,末次随访时实施MARYLAND足部评分,同时进行两组组内和组间的比较。结果两组患者术后1个月GISSANE角和BOHLER角均明显大于术前(P<0.05);术后1个月治疗组患者GISSANE角和BOHLER角均明显大于对照组(P<0.05)。末次随访MARYLAND足部评分对照组平均分为62.43±1.22分,优良率为53.33%;治疗组平均分为85.89±2.06分,优良率为86.67%,治疗组的平均分和优良率均明显高于对照组(P<0.05)。结论切开复位钢板螺钉结合克氏针置入内固定在治疗粉碎性跟骨关节内移位骨折伴后上方骨折患者中能够取得更为理想的骨折复位,促进患者术后骨折愈合,且操作简单,临床疗效明显。Objective To analyze the effects of open reduction and internal fixation with plate screw combined with Kirschner wire on the GISSANE angle,BOHLER angle and MARYLAND score in patients with comminuted calcaneal intra-articular and posterosuperior fractures.Methods 60 cases diagnosed with comminuted calcaneal intra-articular and posterosuperior fractures were randomly selected during 2014-2016 and divided into the control group who underwent open reduction and internal fixation by plate screw only and the treatment group who were treated with open reduction and internal fixation combined plate screw with Kirschner wire,30 cases in each group. The GISSANE and BOHLER angle of the calcaneus were measured from lateral radiograph before and 1 month after surgery and the MARYLAND score was assessed at the last follow-up time,and these records were compared in each group and among different groups. Results The GISSANE angle and BOHLER angle were significantly larger at 1 month after surgery than those of pre-treatment in both groups（ P〈0.05）. The GISSANE angle and BOHLER angle in the treatment group were significantly larger than those in the control group at 1 months after surgery（ P〈0.05）. At the last follow-up,the average score by MARYLAND score in the control group was 62. 43 ± 1. 22,with the excellent and good rate of 53. 33% and the average score in the treatment group was 85. 89 ± 2. 06,with the excellent and good rate of 86. 67%. The average score and the excellent and good rate in the treatment group were significantly higher than those in the control group（ P〈0.05）. Conclusion Open reduction and internal fixation with plate screw combined with Kirschner wire has better efficacy in the treatment of the comminuted calcaneal intra-articular and posterosuperior fractures,promotes to heal fractures with simple operation and obvious curative effects.

关 键 词：粉碎性骨折 后上方骨折 钢板螺钉 克氏针 跟骨 

分 类 号：R687.3[医药卫生—骨科学]