经皮撬拔闭合复位空心钉内固定术治疗跟骨sandersⅡ、Ⅲ型骨折  

Treatment of sandersⅡand sandersⅢfracture of calcaneus with percutaneous prying and closed reduction and internal fixation with hollow nail

作　　者：陈昌斌 龙丁柏 陈兴强 CHEN Changbin;LONG Dingbai;CHEN Xingqiang(Department of Trauma Surgery,Qionghai People’s Hospital,Qionghai,Hainan 571400,China)

机构地区：[1]琼海市人民医院创伤外科,海南省琼海市571400

出　　处：《中南医学科学杂志》2021年第5期603-606,共4页Medical Science Journal of Central South China

摘　　要：目的探讨经皮撬拔闭合复位空心钉内固定术治疗跟骨sandersⅡ、sandersⅢ型骨折,为临床应用提供指导。方法回顾性选择90例sandersⅡ、Ⅲ型跟骨骨折患者,根据手术方式分为对照组与观察组,各45例。对照组行切开复位钢板内固定术,观察组行经皮撬拨闭合复位空心钉内固定术。记录并比较两组手术情况、VAS评分、足踝功能及并发症等情况。结果与对照组比较,观察组患者手术时间、住院时间缩短,术中出血量、术后24 h引流管引流量减少(P<0.05);两组患者术后5天Bohler角、Gussane角、跟骨宽度、跟骨高度均较术前明显改善(P<0.05),而术后两组间差异无显著性(P>0.05);两组术后VAS评分均较术前降低(P<0.05),观察组术后1年VAS评分低于对照组(P<0.05);与对照组比较,观察组Maryland足踝功能评分优良率显著升高(P<0.05);随访期间观察组并发症显著低于对照组(P<0.05)。结论经皮撬拨闭合复位空心钉内固定术能达到切开复位钢板内固定术相似的效果,且在改善远期疼痛、足踝功能方面效果更显著,安全可靠,可在基层医院推广应用。Aim To investigate the treatment of SandersⅡand SandersⅢcalcaneal fractures with percutaneous prying and pulling,closed reduction and cannulated screw internal fixation,so as to provide guidance for clinical application.Methods 90 patients with SandersⅡandⅢcalcaneal fractures were retrospectively divided into control group and observation group,with 45 cases in each group.The control group was treated with open reduction and plate internal fixation,and the observation group was treated with percutaneous prying,closed reduction and cannulated screw internal fixation.The operation,VAS score,foot and ankle function and complications were recorded and compared between the two groups.Results compared with the control group,the operation time and hospital stay in the observation group were shortened,the amount of intraoperative bleeding and the flow of drainage tube 24 hours after operation were reduced(P<0.05);Bohler angle,gussane angle,calcaneal width and calcaneal height were significantly improved in the two groups 5 days after operation(P<0.05),but there was no significant difference between the two groups after operation(P>0.05);The VAS score of the observation group was lower than that of the control group one year after operation(P<0.05);Compared with the control group,the excellent and good rate of Maryland's foot and ankle function score in the observation group was significantly higher(P<0.05);During the follow-up period,the complications in the observation group were significantly lower than those in the control group(P<0.05).Conclusions percutaneous prying closed reduction and cannulated screw internal fixation can achieve the similar effect of open reduction and plate internal fixation,and has more significant effect in improving long-term pain and foot and ankle function.It is safe and reliable,and can be popularized and applied in grass-roots hospitals.

关 键 词：经皮撬拨闭合复位 空心钉内固定术 切开复位 钢板内固定术 临床效果 

分 类 号：R683.42[医药卫生—骨科学]