经皮克氏针撬拨复位支架外固定联合横向空心钉内固定与跗骨窦入路锁定钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的对比研究  

A comparative study of percutaneous Kirschner-wires leverage reduction and frame external fixation combined with lateral hollow screw internal fixation versus locking plate internal fixation through sinus tarsal approach for treatment of Sanders typeⅡandⅢcalcaneal fractures

作　　者：陈俊杰 李铭雄 魏志勇 孔祥标 余福钦 陈王 CHEN Junjie;LI Mingxiong;WEI Zhiyong;KONG Xiangbiao;YU Fuqin;CHEN Wang(Quanzhou Orthopedic-Traumatological Hospital,Quanzhou 362000,Fujian,China)

机构地区：[1]泉州市正骨医院,福建泉州362000

出　　处：《中医正骨》2022年第8期25-30,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较经皮克氏针撬拨复位支架外固定联合横向空心钉内固定与跗骨窦入路锁定钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效和安全性。方法:回顾性分析42例SandersⅡ、Ⅲ型跟骨骨折患者的病例资料,其中采用经皮克氏针撬拨复位支架外固定联合横向空心钉内固定治疗20例(联合固定组)、采用跗骨窦入路锁定钢板内固定治疗22例(锁定钢板内固定组)。比较2组患者的手术时间、住院时间;提取患者术前及术后1周X线片,测量并比较2组患者术前及术后1周跟骨形态指标(跟骨宽度、跟骨高度、Bhler角及Gissane角);比较2组患者术后12个月美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及并发症发生率。结果:①一般指标。联合固定组患者的手术时间、住院时间均短于锁定钢板内固定组[(76.90±21.49)min,(123.86±34.81)min,Z=-4.317,P=0.000;(10.55±3.65)d,(13.91±4.01)d,t=-2.829,P=0.007]。②跟骨形态指标。2组患者术前及术后1周跟骨高度、跟骨宽度、Bhler角、Gissane角比较,组间差异均无统计学意义[术前:(38.97±3.09)mm,(39.27±3.28)mm,t=-0.307,P=0.760;(42.85±3.03)mm,(41.82±4.56)mm,t=0.854,P=0.398;6.45°±4.20°,7.32°±4.63°,Z=-0.709,P=0.478;103.90°±10.92°,100.59°±8.78°,t=1.087,P=0.284;术后1周:(48.37±3.52)mm,(49.14±3.28)mm,t=-0.730,P=0.470;(37.19±3.67)mm,(36.41±3.72)mm,t=0.679,P=0.501;28.50°±4.34°,26.68°±4.08°,t=1.401,P=0.169;128.20°±4.74°,126.64°±5.23°,t=1.011,P=0.318];2组患者术后1周跟骨高度、Bhler角和Gissane角均大于术前(高度:t=-8.974,P=0.000;t=-9.965,P=0.000;Bhler角:t=-16.340,P=0.000;t=-5.643,P=0.000;Gissane角:t=-9.131,P=0.000;t=-11.951,P=0.000),跟骨宽度均小于术前(t=5.318,P=0.000;t=4.305,P=0.000)。③AOFAS踝与后足评分。联合固定组获随访17例,锁定钢板内固定组获随访21例。2组患者术后12个月AOFAS踝与后足评分比较,差异无统计学意义[(85.59±11.97)Objective:To compare the clinical outcomes and safety of percutaneous Kirschner-wires(K-wires)leverage reduction and frame external fixation combined with lateral hollow screw internal fixation versus locking plate internal fixation through sinus tarsal approach(STA)in treatment of Sanders typeⅡandⅢcalcaneal fractures.Methods:The medical records of 42 patients with Sanders typeⅡandⅢcalcaneal fractures were analyzed retrospectively.Twenty patients were treated with percutaneous K-wires leverage reduction and frame external fixation combined with lateral hollow screw internal fixation(combination fixation group)and 22 ones with locking plate internal fixation through STA(locking plate internal fixation group).The operative time and hospital stays were compared between the 2 groups.The X-ray films taken before the surgery and at postsurgical week 1 were extracted,and the calcaneal width,calcaneal height,Bhler angle and Gissane angle were compared between the 2 groups.Furthermore,the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score evaluated at postsurgical month 12 and complication incidence were compared between the 2 groups.Results:①The operative time and hospital stays were shorter in combination fixation group comapred to locking plate internal fixation group(76.90±21.49 vs 123.86±34.81 minutes,Z=-4.317,P=0.000;10.55±3.65 vs 13.91±4.01 days,t=-2.829,P=0.007).②There was no statistical difference in presurgical and postsurgical Week-1 calcaneal height,calcaneal width,Bhler angle and Gissane angle between the 2 groups(presurgical:38.97±3.09 vs 39.27±3.28 mm,t=-0.307,P=0.760;42.85±3.03 vs 41.82±4.56 mm,t=0.854,P=0.398;6.45±4.20 vs 7.32±4.63 degrees,Z=-0.709,P=0.478;103.90±10.92 vs 100.59±8.78 degrees,t=1.087,P=0.284;postsurgical week 1:48.37±3.52 vs 49.14±3.28 mm,t=-0.730,P=0.470;37.19±3.67 vs 36.41±3.72 mm,t=0.679,P=0.501;28.50±4.34 vs 26.68±4.08 degrees,t=1.401,P=0.169;128.20±4.74 vs 126.64±5.23 degrees,t=1.011,P=0.318).The calcaneal height,Bhler angle and Giss

关 键 词：跟骨 骨折固定术 临床试验 

分 类 号：R687.3[医药卫生—骨科学]