经皮空心螺钉与开放钛板固定治疗跟骨骨折的比较  

Percutaneous cannulated screw versus conventional titanium plate for calcaneal fracture

作　　者：张培[1] 吴敏[1] 官建中[1] 刘泉[1] 肖玉周[1] 周平辉[1] 王旭义[1] ZHANG Pei;WU Min;GUAN Jian-zhong;LIU Quan;X;ZHOU Ping-hui;WANG Xu-yi(Department of Orthopaedics,The First Affiliated Hospital,Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院骨科组织移植安徽省重点实验室,安徽蚌埠233004

出　　处：《中国矫形外科杂志》2018年第18期1664-1669,共6页Orthopedic Journal of China

基　　金：安徽省高校省级自然科学研究重点项目(编号:KJ2016A870)

摘　　要：[目的]对比分析经皮撬拨复位空心螺钉与"L"形切口切开复位钛板治疗跟骨关节内骨折临床疗效。[方法]回顾性分析41例45足SandersⅡ、Ⅲ型跟骨骨折患者,所有均为新近骨折,分成经皮组21例23足,"L"形切开组20例22足。记录术前准备时间、出血量及住院天数,采用AOFAS评分,影像测量Bohler角、Gissane角、高度、宽度评价临床结果。[结果]所有患者均顺利手术,无严重并发症。经皮组术前准备时间、失血量、早期并发症发生率和住院时间均明显少于切开组,差异有统计学意义(P<0.05)。两组均获得随访,随访时间12~36个月,平均(24.29±4.69)个月,经皮组和切开组临床骨折愈合时间[(17.09±2.27)周vs(17.59±2.91)周,P>0.05]差异无统计学意义。AOFAS评分[(88.82±5.97)vs(88.09±7.37),P>0.05]两组间差异无统计学意义。在影像测量方面,两组患者的术后Bohler、Gissane角、高度均较术前显著增加,而宽度、距下关节面移位均显著减少,两时间点上述指标的差异均有统计学意义(P<0.05)。但两组间各时间点在Bohler角、Gissane角,跟骨高度、宽度和距下关节面移位的差异均无统计学意义(P>0.05)。[结论]对于SandersⅡ、Ⅲ型跟骨骨折,经皮微创撬拨复位空心螺钉固定与传统"L"形切口切开复位固定均能够达到良好的疗效,前者在减轻患者创伤、降低术后并发症发生率、缩短住院时间等相对后者明显优越。[Objective] To compare the clinical outcomes of percutaneous minimally invasive poking reduction combined with cannulated screw fixation versus open reduction plus titanium plate fixation through the conventional L-shaped incision for calcaneal fracture. [Methods] A retrospective study was conducted on 41 patients（45 feet） with Sanders type Ⅱ and Ⅲ fresh calcaneal fracture. Of them, 21 patients（23 feet） received percutaneous minimally invasive poking reduction and cannulated screw fixation（the percutaneous group）, while the remaining 20 patients（22 feet） underwent open reduction and plate fixation through the conventional L-shaped incision（the open group）. The operation time, blood loss, hospital stay, complication and AOFAS score, as well as radiographic measures, such as Bohler angle, Gissane angle, calcaneal height and width were compared between the two groups. [Results] All the patients had operation conducted successfully with no serious intraoperative complication. The percutaneous group took significantly shorter preoperative preparing time, less blood loss and lower incidence of early complication than the open group with statistical differences between the two groups（P〈0.05）. The patients were followed up for12 to 36 months with an average of（24.29±4.69） months. Regarding to fracture healing time, the percutaneous group was similar to the open group without a statistical difference [（17.09± 2.27） w vs（17.59± 2.91） w, P〉0.05]. At the latest follow up, the AOFAS scores proved [（88.82± 5.97） vs（88.09± 7.37）, P〉0.05]. In term of radiographic measures, the Bohler angle, Gissane angle, calcaneal height significantly increased, while the calcaneal width and subsidence of subtalar joint significantly decreased after operation in both groups（P〈0.05）, however, no statistical differences were noticed between the two groups in any of aforesaid parameters at any time point（P〉0.05）. [Conclusions] For Sanders type II and type III calcaneal fracture

关 键 词：跟骨骨折 经皮撬拨复位 开放复位 内固定 空心螺钉 钛板 

分 类 号：R683.42[医药卫生—骨科学]