经皮微创和切开复位内固定治疗Sanders Ⅰ、Ⅱ型跟骨骨折的临床疗效比较  

Clinical Efficacy Comparison of Percutaneous Minimally Invasive Treatment and Open Reduction Internal Fixation for Sanders Type Ⅰ and Ⅱ Calcaneal Fractures

作　　者：陈姚飞[1] 黄新 CHEN Yaofei;HUANG Xin(Department of Orthopedics,Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine,Jiangyin 214400,China)

机构地区：[1]南京中医药大学江阴附属医院骨科

出　　处：《医学综述》2019年第22期4580-4584,共5页Medical Recapitulate

摘　　要：目的比较经皮微创法和切开复位内固定治疗SandersⅠ、Ⅱ型跟骨骨折的临床疗效。方法回顾性分析2014年1月至2019年3月南京中医药大学江阴附属医院骨科收治的42例(44足)SandersⅠ、Ⅱ型跟骨骨折患者的临床资料。其中16例(17足)采用经皮撬拨复位螺钉内固定法(微创组),26例(27足)采用外侧“L”切口切开复位钢板内固定法(对照组)。比较两组患者的手术时间、术中出血量、术前和术后住院时间、美国足踝外科协会(AOFAS)评分,术前与术后跟骨Bohler角、Gissane角与跟骨宽度以及切口并发症情况。结果①42例病例(44足)术后平均随访13.5个月,两组手术时间、术中出血量、术后住院时间、术前Bohler角比较差异有统计学意义(P<0.05),两组术前住院时间和术后AOFAS评分比较差异无统计学意义(P>0.05)。②影像学结果比较:各组术后Bohler角、Gissane角、跟骨宽度较术前有明显改善(P<0.05),且手术方式与术前、术后时点不存在交互效应(P>0.05);对照组Bohler角小于微创组,对照组跟骨宽度大于微创组,两组间Bohler角、跟骨宽度比较差异有统计意义(P<0.05),两组间Gissane角比较差异无统计意义(P>0.05)。③术后并发症比较:对照组切口感染1例、皮缘坏死5例、腓肠神经损伤1例;微创组未出现感染、皮肤坏死、神经损伤病例,微创组并发症发生率低于对照组(P<0.05)。结论经皮微创法治疗SandersⅠ、Ⅱ型跟骨骨折具有手术时间短、出血量少、住院时间短、术后并发症少的优势,其临床疗效与切开复位内固定法相似。Objective To compare the clinical efficacy of percutaneous minimally invasive surgery and open reduction internal fixation for the treatment of SandersⅠandⅡcalcaneal fractures.Methods The clinical data of 42 patients(44 feet)with SandersⅠandⅡcalcaneal fractures admitted to the Department of Orthopedics,Jiangyin Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from Jan.2014 to Mar.2019 were retrospectively analyzed.Among them,the percutaneous minimally invasive group(16 patients,17 feet)was treated with percutaneous reduction and internal fixation,and the incision group(26 patients,27 feet)was treated with a lateral"L"incision and reduction plate internal fixation.Surgical time,intraoperative blood loss,preoperative and postoperative hospital stay,American Foot and Ankle Surgery Association(AOFAS)score,preoperative and postoperative calcaneus Bohler angle,Gissane angle and calcane width,and incision complications were compared between the two groups.Results①The 42 cases(44 feet)were followed up for an average of 13.5 months.There were statistical differences between the two groups in operation time,blood loss,postoperative hospital stay,and preoperative Bohler angle(P<0.05).There was no significant difference in preoperative hospital stay and postoperative AOFAS score between the two groups(P>0.05).②Comparison of imaging results:The postoperative Bohler angle,Gissane angle and calcane width were significantly improved in each group(P<0.05),and there was no interaction between the operation mode and preoperative and postoperative time points(P>0.05).The Bohler angle of the control group was smaller than that of the minimally invasive group and the width of the calcaneus was larger than that of the minimally invasive group.The differences of Bohler angle and calcane width between the two groups were statistically significant(P<0.05).There was no statistical difference in the Gissane angle between the two groups(P>0.05).③Postoperative complications:1 case of incision infection,5

关 键 词：跟骨骨折 撬拨复位 微创手术 切开复位 

分 类 号：R274.1[医药卫生—中医骨伤科学] R687.3[医药卫生—中医学]