撬拨复位微创置板与经“L”型切口内固定治疗跟骨骨折的比较  

Comparison of percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation in the treatment of calcaneal fracture

作　　者：郑志辉[1] 蔡沛彪 关可立 李晓武[1] 郑洵 陈海波[1] 曾庆强[1] Zheng Zhihui;Cai Peibiao;Guan Keli;Li Xiaowu;Zheng Xun;Chen Haibo;Zeng Qingqiang(Second Department of Orthopedics,Shantou Hospital of Traditional Chinese Medicine(Shantou Hospital Affiliated to Guangzhou University of Chinese Medicine),Shantou 515031,Guangdong Province,China)

机构地区：[1]汕头市中医医院(广州中医药大学附属汕头医院)骨二科

出　　处：《中国组织工程研究》2020年第15期2342-2348,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:涉及距下关节的跟骨关节内骨折约占全部跟骨骨折的75%,而对于移位型跟骨关节内骨折,手术治疗要优于非手术治疗。然而对于治疗时机、手术指征、切口选择、是否植骨等问题目前仍有争议。经典的“L”型入路因其较高的切口并发症而有逐渐被微创内固定所取代的趋势。目的:比较撬拨复位微创置板及“L”型切口切开复位钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法:选择汕头市中医院骨二科2016年1月至2019年1月收治的SandersⅡ、Ⅲ型跟骨骨折患者60例,随机分为撬拨复位微创置板组(n=32)和“L”型切口组(n=28),分别采用闭合撬拨复位微创置板和经“L”型切口切开复位钢板内固定治疗。术后6个月末次随访按美国矫形外科足踝协会评分优良率评价2组手术疗效,对比2组患者术前等待天数、手术时间、住院天数及并发症发生率,术前、术后及末次随访时分别测定患者Böhler角、Gissane角并加以比较。结果与结论:①撬拨复位微创置板组美国矫形外科足踝协会评分优良率为91%,“L”型切口组为93%,2组比较差异无显著性意义(P>0.05);②2组术后Böhler角、Gissane角均较术前明显改善(P<0.05);术后1 d 2组Gissane角相当(P>0.05),Böhler角变化“L”型切口组优于撬拨复位微创置板组(P<0.05);末次随访2组Böhler角及Gissane角均有不同程度丢失,差异无显著性意义(P>0.05);③“L”型切口组患者的术前等待天数、住院天数均多于撬拨复位微创置板组(P<0.05);手术时间少于撬拨复位微创置板组(P<0.05);④撬拨复位微创置板组并发症发生率为9%,低于“L”型切口组的32%(P<0.05);⑤提示与传统“L”型切口切开复位内固定相比,撬拨复位微创置板治疗SandersⅡ、Ⅲ型跟骨骨折临床疗效满意,创伤小,并发症少,值得临床推荐。BACKGROUND:Intra-calcaneal fractures involving subtalar joints account for about 75%of all calcaneal fractures.Surgical treatment of displaced intra-articular calcaneal fractures is superior to non-surgical treatment.However,the timing of treatment,surgical indications,incision selection,and bone grafting are still controversial.The classical“L”approach is gradually replaced by minimally invasive internal fixation because of its high incision complications.OBJECTIVE:To compare the clinical effect of minimally invasive internal fixation and“L”incision for the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.METHODS:Sixty patients with Sanders Ⅱ or Ⅲ calcaneal fractures from January 2016 to January 2019 in the Second Department of Orthopedics,Shantou Hospital of Traditional Chinese Medicine were randomly divided into minimal invasion group(n=32)and“L”incision group(n=28).The patients in the minimal invasion group and“L”incision group received percutaneous reduction by leverage combined with minimally invasive internal fixation and“L”incision internal fixation treatment,respectively.At 6 months after operation,the curative effect of the two groups was evaluated according to the American Orthopedic Foot and Ankle Society score.Preoperative waiting days,the operation time,the length of stay and the complication incidence were compared between the two groups.Böhler angle and Gissane angle were measured and compared preoperatively,postoperatively and during the final follow-up.RESULTS AND CONCLUSION:(1)The excellent and good rate of American Orthopedic Foot and Ankle Society score was 91%in the minimal invasion group and 93%in the“L”incision group(P>0.05).(2)The postoperative Böhler angle and Gissane angle were significantly improved in both groups(P<0.05).At postoperative 1 day,Gissane angle of two groups was equivalent(P>0.05).Böhler angle was better in the“L”incision group than in the minimal invasion group(P<0.05).At the final follow-up,both groups had different degrees of decr

关 键 词：跟骨骨折 SandersⅡ、Ⅲ型 撬拨复位 微创置板内固定 “L”型切口 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]