改良小切口复位植骨联合经皮克氏针内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床研究  

Clinical research of modified small incision reduction bone graft combined with percutaneous Kirschner internal fixation for the treatment of Sanders Ⅱ,Ⅲ calcaneal fractures

作　　者：刘核达[1] 刘林 黄飞 左俊水[1] 杨宗宇[1] 李森田[1] LIU He-da;LIU Lin;HUANG Fei;ZUO Jun-shui;YANG Zong-yu;LI Sen-tian(Ninth Department of Orthopaedics,Cangzhou Integrated Traditional Chinese and Western Medicine Hospital,Cangzhou,Hebei 061001,China)

机构地区：[1]沧州中西医结合医院骨九科,河北061001

出　　处：《创伤外科杂志》2018年第10期744-748,共5页Journal of Traumatic Surgery

摘　　要：目的探讨改良小切口复位植骨联合经皮克氏针内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效及并发症。方法 2015年1月—2017年5月沧州中西医结合医院骨科收治Sanders Ⅱ、Ⅲ型跟骨骨折患者91例,按照随机数字表法,将患者分为切开复位钢板内固定治疗组45例(切开复位组)和改良小切口复位植骨联合经皮克氏针内固定治疗组46例(改良组)。切开复位组中男性25例,女性20例;年龄23～67岁,平均46. 0岁;骨折原因:高处坠落伤28例,道路交通伤17例。改良组中男性24例,女性22例;年龄23～68岁,平均46. 1岁;骨折原因:高处坠落伤29例,道路交通17例。分析统计治疗后的临床优良率,患者的住院情况,同时观察患者手术前后Bohler角、Gissane角、踝-后足评分(American orthopedic foot and ankle society,AOFAS),跟骨长度、宽度及高度,观察术后并发症发生情况。结果改良组患者临床优良率为93. 48%(43/46)明显高于切开复位组的62. 22%(28/45),两组比较差异有统计学意义(P <0. 05)。改良组患者出血量、伤口愈合时间及住院时间均明显低于切开复位组,分别为[(25. 17±7. 62) mL vs.(69. 25±10. 54) mL、(5. 42±1. 03) d vs.(10. 57±2. 69) d、(6. 04±1. 21) d vs.(12. 19±3. 68) d],而手术时间和费用均显著高于切开复位组,分别为[(95. 24±20. 58) min vs.(60. 12±15. 23) min、(1. 09±0. 03)万元vs.(0. 68±0. 04)万元],两组比较差异均有统计学意义(P <0. 05);与治疗前相比,两组患者治疗后Bohler角、Gissane角、AOFAS、跟骨长度及高度明显升高,而跟骨宽度显著下降,同时改良组患者治疗后临床指标的改善情况明显优于切开复位组,且差异均有统计学意义(P <0. 05);改良组患者术后并发症发生率为4. 35%,明显低于切开复位组的17. 78%(P <0. 05)。结论改良小切口复位植骨联合经皮克氏针内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效显著,能够改善患者的住院情况及临床相�Objective To explore the clinical curative effect and complications of modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation for the treatment of Sanders Ⅱ,Ⅲ calcaneal fractures. Methods According to the random number table method,91 patients with Sanders Ⅱ,Ⅲ calcaneal fractures from Jan. 2015 to May 2017 admitted in Cangzhou Integrative Medicine Hospital were treated by open reduction and plate internal fixation （45 cases,open reduction group） and modified small incision reduction and bone graft combined with percutaneous Kirschner internal fixation （46 cases,modified group）. Open reduction group consisted of 25 cases of men and 20 cases of women with age of 23-67 years（average 46.0 years）. Fracture reasons included 28 cases of falling injury and 17 cases of road traffic injury. The modified group consisted of 24 cases of men and 22 cases of women aged 23-68 years（average 46.1 years）. Fracture reasons included 29 cases of high falling injury and 17 cases of road traffic accident. The clinical efficiency after treatment and the hospitalization of patients were analyzed. At the same time,the Bohler Angle,Gissane Angl,ankle-hind score （AOFAS）,heel bone length,width and height were observed before and after surgery. In addition,the postoperative complications were observed. Results The clinical excellent and good rate of patients in the modified group was 93.48% （43/46）,which was significantly higher than 62.22% （28/45） in the open reduction group,and the difference between the two groups was statistically significant （ P 〈0.05）. Compared with the open reduction group,the blood loss,wound healing time and hospital stay of the modified group were significantly lower （（25.17±7.62）mL vs.（69.25 ±10.54）mL,（5.42±1.03）d vs.（10.57 ±2.69）d,（6.04 ±1.21）d vs.（12.19 ±3.68）d）,and the operation time and cost were significantly higher than those of the open reduction group. The differences between the tw

关 键 词：跟骨骨折 小切口 复位植骨 克氏针 内固定 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]