微创撬拔复位空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究  

Clinical study of minimally invasive prying reduction and internal fixation with hollow nails for SandersⅡandⅢcalcaneal fractures

作　　者：李军 梁周 黄志雄 吴金道 李玉莲 詹柱亨 LI Jun;LIANG Zhou;HUANG Zhi-xiong;WU Jin-dao;LI Yu-lian;ZHAN Zhu-heng(Department of OrthopaedicsⅠ,Maoming Hospital of Traditional Chinese Medicine,Maoming 525000,Guangdong,CHINA)

机构地区：[1]茂名市中医院骨一科,广东茂名525000

出　　处：《海南医学》2020年第11期1429-1432,共4页Hainan Medical Journal

摘　　要：目的探讨微创撬拔复位空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效,为患者的临床诊治提供理论依据。方法选取2014年6月至2018年6月茂名市中医院骨一科收治的110例SandersⅡ、Ⅲ型跟骨骨折患者进行研究,采用随机数表法将患者均分为观察组和对照组各55例。对照组患者实施外侧L型切口钢板螺钉固定治疗,观察组患者实施微创撬拔复位空心钉内固定治疗。比较两组患者各项手术指标、不同时段疼痛评分、治疗前及治疗结束6个月后的跟骨宽度、Bohler角和Gissane角及并发症发生率。结果观察组和对照组患者的手术时间[(79.46±21.56) min vs (93.45±21.57) min]、住院时间[(5.69±1.17) d vs (7.42±1.19) d]、术中出血量[(82.76±5.11) mL vs (94.51±5.12) m L]比较,观察组明显少于或短于对照组,差异均有统计学意义(P<0.05);两组患者术后1 d的疼痛评分比较差异无统计学意义(P>0.05);术后3 d、5 d、7 d,观察组患者的疼痛评分[(1.83±0.51)分、(1.51±0.44)分、(1.45±0.38)分]明显低于对照组[(2.67±0.52)分、(2.39±0.45)分、(2.30±0.39)分],差异均有统计学意义(P<0.05);治疗前,两组患者跟骨宽度、Bohler角、Gissane角比较差异均无统计学意义(P>0.05);治疗结束6个月后,观察组和对照组患者的跟骨宽度[(34.35±5.01) mm vs (30.39±5.02) mm]、Bohler角[(38.91±4.52)°vs (35.76±4.57)°]、Gissane角[(112.54±12.07)°vs(106.50±12.08)°]比较,观察组改善程度明显优于对照组,差异均有统计学意义(P<0.05);观察组患者并发症发生率为1.82%,明显低于对照组的12.73%,差异有统计学意义(P<0.05)。结论微创撬拔复位空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折能有效降低患者的术中出血量,缩短手术时间,且手术安全性较高,临床治疗效果显著,值得推广使用。Objective To explore the clinical efficacy of minimally invasive prying reduction and internal fixation with hollow nails in the treatment of SandersⅡandⅢcalcaneal fractures,and to provide theoretical basis for the clinical diagnosis and treatment of patients.Methods A total of 110 patients with SandersⅡandⅢcaleneal fractures admitted to Department of OrthopaedicsⅠ,Maoming Hospital of Traditional Chinese Medicine from June 2014 to June 2018 were selected for the study.The patients were divided into observation group and control group by random number table method,with 55 patients in each group.The patients in the control group were treated with lateral L-incision plate and screw fixation,and the patients in the observation group were treated with minimally invasive prying reduction and internal fixation with hollow nails.The operation indexes,pain scores in different periods of time,and calcaneal width,Bohler angle,and Gissane angle before treatment and 6 months after treatment,and the incidence of complications were compared between the two groups.Results The observation group was significantly less or shorter than the control group in the following indexes(P<0.05):operation time,(79.46±21.56)min vs(93.45±21.57)min;length of hospital stay,(5.69±1.17)d vs(7.42±1.19)d;intraoperative blood loss,(82.76±5.11)mL vs(94.51±5.12)mL.The pain scores at 1 day after surgery showed no statistically significant difference between the two groups(P>0.05).At 3 d,5 d,7 d after surgery,the pain scores in the observation group were(1.83±0.51)points,(1.51±0.44)points,(1.45±0.38)points,significantly lower than(2.67±0.52)points,(2.39±0.45)points,(2.30±0.39)points in the control group(P<0.05).Before treatment,the calcaneus width,Bohler angle,and Gissane angle showed no statistically significant difference between the two groups(P>0.05);six months after treatment,the calcaneus width,Bohler Angle,and Gissane Angle of the observation group were significantly better than those of the control group(P>0.05):(34.35±5.01)

关 键 词：微创撬拔复位空心钉内固定 SandersⅡ、Ⅲ型 跟骨骨折 疼痛 疗效 并发症 

分 类 号：R683.42[医药卫生—骨科学]