撬拨复位微创置板与改良经跗骨窦小切口及经“L”型切口内固定治疗跟骨骨折临床疗效分析  

Clinical effect of poking reduction and minimally invasive plate placement,modified small incision through the tarsal sinus and internal fixation through“L”incision in the treatment of calcaneal fractures

作　　者：姚涛[1] 王磊 陶勇[1] 贾天米 Yao Tao;Wang Lei;Tao Yong;Jia Tianmi(Department of Traumatology and Orthopedics,Hefei First People’s Hospital,Hefei 230041,China)

机构地区：[1]合肥市第一人民医院创伤骨科,合肥230041

出　　处：《创伤外科杂志》2022年第4期289-294,共6页Journal of Traumatic Surgery

摘　　要：目的探讨撬拨复位微创置板与改良经跗骨窦小切口及经“L”型切口内固定治疗跟骨骨折的临床疗效。方法前瞻性研究2019年1月—2021年5月合肥市第一人民医院创伤骨科收治的108例Sanders分型Ⅱ~Ⅲ型跟骨骨折患者,按照随机数字表法分为A组(采用撬拨复位微创置板内固定术)、B组(采用改良经跗骨窦小切口空心钉内固定术)、C组(采用L型切口钢板内固定术),各36例。A组男性18例,女性18例;年龄21~65岁,平均42.3岁;致伤原因高处坠落伤11例,摔伤15例,道路交通伤10例。B组男性19例,女性17例;年龄20~66岁,平均42.4岁;致伤原因高处坠落伤10例,摔伤14例,道路交通伤12例。C组男性20例,女性16例;年龄22~64岁,平均42.3岁;致伤原因高处坠落伤13例,摔伤14例,道路交通伤9例。对比观察三组手术时间、住院时间、术中出血量,评估优良率、Bohler角、Gissane角、跟骨宽度,观察并发症情况。结果B组手术时间少于A组与C组A、B、C组分别为(72.68±10.05)min vs.(50.52±6.32)min vs.(100.25±12.32)min,P<0.05;A组住院时间短于C组(11.41±1.65)d vs.(14.28±2.32)d,B组短于C组(11.32±1.69)d vs.(14.28±2.32)d,P<0.05;A组术中出血量少于B组与C组(23.52±4.02)mL vs.(41.65±6.25)mL vs.(72.25±9.65)mL,P<0.05。A组优良率(97.22%)高于B组(83.33%)及C组(66.67%),而并发症总发生率(2.78%)低于B组(22.22%)和C组(33.33%),P<0.05。重复测量方差分析显示,三组Bohler角、跟骨宽度的时点、交互比较,差异有统计学意义(P<0.05),而组间比较差异无统计学意义(P>0.05);三组Gissane角时点比较,差异有统计学意义(P<0.05),而组间、交互比较差异无统计学意义(P>0.05);两两比较显示,术前A组与B、C组Bohler角、Gissane角、跟骨宽度差异无统计学意义(P>0.05);术后A组Bohler角大于C组(34.65±8.52)°vs.(30.21±6.85)°,跟骨宽度短于C组(30.05±3.11)mm vs.(34.12±3.96)mm,P<0.05。结论撬拨复位微创置板内固定术治疗跟骨骨折效果Objective To investigate the clinical efficacy of poking reduction,minimally invasive plate placement,modified small incision through the sinus tarsi and internal fixation through“L”-shaped incision in the treatment of calcaneal fractures.Methods From Jan.2019 to May 2021,108 patients with Sanders classification II-III calcaneal fractures who were admitted to the Department of Traumatology and Orthopedics of Hefei First People’s Hospital were prospectively selected and divided into three groups according to the random number table method,group A(using prying reduction,minimally invasive plate internal fixation),group B(using modified transtarsal small incision cannulated screw internal fixation),group C(using L-shaped incision plate internal fixation),with 36 cases in each group.In group A,there were 18 males and 18 females,age ranging from 21 to 65 years,with an average age of 42.3 years.Causes of injury:11 cases of high falling,15 cases of falling and 10 cases of traffic accident.In group B,there were 19 males and 17 females,age ranging from 20 to 66 years,with an average age of 42.4 years.Causes of injury:10 cases of high falling,14 cases of falling and 12 cases of traffic accident.In group C,there were 20 males and 16 females,age ranging from 22 to 64 years,with an average age of 42.3 years.Causes of injury:13 cases of high falling,14 cases of falling and 9 cases of traffic accident.The operation time,hospital stay,intraoperative blood loss,excellent and good rate,Bohler angle,Gissane angle,and calcaneal width were compared and observed,and complications were observed.Results The operation time of group B was less than that of group A and group C[groups A,B,C were(72.68±10.05)minutes,(50.52±6.32)minutes,(100.25±12.32)minutes,P<0.05].The hospital stay in group A was shorter than that in group C[(11.41±1.65)days vs.(14.28±2.32)days],and group B was shorter than that in group C[(11.32±1.69)days vs.(14.28±2.32)days],P<0.05.The intraoperative blood loss in group A was less than that in groups B and C[

关 键 词：跟骨骨折 复位 微创 内固定 切口 

分 类 号：R683.42[医药卫生—骨科学]