骨外固定器固定联合术后高压氧治疗跟骨骨折的临床疗效分析  

Clinical study on treatment of calcaneal fracture with external fixation combined with postoperative hyperbaric oxygen

作　　者：陈志明 黄浩 Chen Zhiming;Huang Hao(Department of Bone 3,Huangshi Traditional Chinese Medicine Hospital,Huangshi Medical Group,Huangshi,Hubei 435000,China)

机构地区：[1]鄂东医疗集团黄石市中医医院骨3科,湖北黄石435000

出　　处：《创伤外科杂志》2021年第11期833-836,共4页Journal of Traumatic Surgery

摘　　要：目的探讨骨外固定器固定联合术后高压氧治疗跟骨骨折的效果及对骨折区骨密度水平的影响。方法前瞻性分析2017年2月—2020年4月鄂东医疗集团黄石市中医医院收治的病程在2周内的跟骨骨折患者60例临床资料,其中男性35例,女性25例;年龄45~69岁,平均48.7岁;体质量指数平均(24.4±1.4)kg/m2;Sanders分型Ⅰ~Ⅱ型27例,Ⅲ~Ⅳ型33例。按随机数字表法将患者分为对照组及观察组各30例。对照组采用骨外固定器固定治疗,观察组采用骨外固定器联合术后高压氧治疗,纯氧气吸入治疗2次,每次45min,治疗时的压力为0.2MPa,每天治疗1次,10d为1个疗程,治疗3个疗程。比较两组患者骨痂生长情况、骨密度、生命质量、功能恢复及皮肤坏死、切口感染并发症发生率的差异。结果治疗1个月及2个月后,两组骨折部位骨痂生长情况评分比较差异无统计学意义;治疗3个月后,观察组骨折部位骨痂生长情况评分显著高于对照组(2.6±0.1)分vs.(2.5±0.2)分,P<0.05。两组骨密度均较治疗前显著升高,且观察组显著高于对照组(0.78±0.14)g/cm2 vs.(0.62±0.11)g/cm2,P<0.001;观察组患者的生理功能、生理职能、躯体疼痛、一般健康、精力、社会功能、情感职能、心理健康各项指标评分显著高于对照组(75.36±6.35)分vs.(67.32±7.11)分、(71.38±3.83)分vs.(60.54±3.76)分、(73.32±9.75)分vs.(67.38±9.36)分、(73.76±10.63)分vs.(63.74±10.17)分、(77.34±5.36)分vs.(69.37±5.33)分、(78.35±13.39)分vs.(63.38±13.14)分、(73.32±7.91)分vs.(68.64±8.37)分、(75.68±10.13)分vs.(68.36±10.04)分,P<0.05;两组患者的Kerry评分均较治疗前显著升高,且观察组显著高于对照组(89.2±1.7)分vs.(74.1±1.7)分,P<0.001。两组并发症发生率比较差异无统计学意义(17%vs.30%,P>0.05)。结论骨外固定器固定联合术后高压氧治疗跟骨骨折,患者的骨密度水平得到显著改善,骨愈合时间显著缩短,建议临床推广。Objective To investigate the effect of external fixator combined with postoperative hyperbaric oxygen(HBO)in the treatment of calcaneal fracture and its influence on bone mineral density in fracture area.Methods Sixty cases of calcaneal fractures treated in Huangshi Traditional Chinese Medicine Hospital from Feb.2017 to Apr.2020 were selected as the study subjects.There were 35 males and 25 females,with an average of 48.7 years(range,45-69 years).The average body mass index was(24.4±1.4)kg/m2;according to Sanders type classification,there were 27 cases of typeⅠ-Ⅱand 33 cases of typeⅢ-Ⅳ.According to the random number table method,the above patients were randomly divided into control group and observation group,with 30 cases in each group.The control group was treated with external fixator fixation,and the observation group was treated with external fixator fixation combined with postoperative HBO treatment.Pure oxygen inhalation was performed twice a day for 45 minutes each time,the pressure during treatment was 0.2 MPa.Ten-day was one treatment course,and the treatment lasted for 3 courses.The differences of callus growth,bone mineral density,quality of life,functional recovery and occurrence rate of complications including cutaneous necrosis and infection of incisional wound were compared between the two groups.Results There was no significant difference in the callus growth score between the observation group and control group after 1 and 2 months of treatment.After 3 months of treatment,the callus growth score of the observation group was significantly higher than that of the control group[(2.6±0.1)points vs.(2.5±0.2)points,P<0.05];the bone mineral density of the two groups was significantly increased,and the bone mineral density of the observation group was significantly higher than that of the control group[(0.78±0.14)g/cm2 vs.(0.62±0.11)g/cm2,P<0.001].The scores of physiological function[(75.36±6.35)points vs.(67.32±7.11)points],role physical[(71.38±3.83)points vs.(60.54±3.76)points],physic

关 键 词：跟骨骨折 高压氧 外固定器 

分 类 号：R683.42[医药卫生—骨科学]