两种内固定治疗SandersⅡ型跟骨骨折的疗效比较  

Comparison effects of two types of internal fixation on Sanders typeⅡcalcaneal fractures

作　　者：朱康[1] 王晓桐[1] 尹金旺 ZHU Kang;WANG Xiao-tong;YIN Jin-wang(Dept of Orthopaedics and Traumatology,Changping District Traditional Chinese Medicine Hospital,Beijing 102200,China)

机构地区：[1]北京市昌平区中医医院骨伤科,北京102200

出　　处：《临床骨科杂志》2025年第1期122-126,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较跗骨窦切口钢板内固定与撬拨复位空心钉内固定治疗SandersⅡ型跟骨骨折的疗效。方法将60例SandersⅡ型跟骨骨折患者按照随机数字表法分为观察组(采用撬拨复位空心钉内固定治疗,30例)和对照组(采用跗骨窦切口钢板内固定治疗,30例)。比较两组围手术期指标、术后并发症发生情况、踝关节活动度、骨折愈合情况、疼痛VAS评分、影像学指标。采用AOFAS踝-后足评分评价疗效。结果患者均获得12个月随访。术中出血量、手术时间、住院时间观察组均少(短)于对照组(P<0.01)。两组Gissane角、Böhler角、跟骨宽度及高度术后1个月均优于术前(P<0.05)。两组踝关节活动度末次随访时均大于术后1个月(P<0.05)。随时间延长,两组骨痂生长评分均逐步上升(P<0.05)。术后1、2、3个月骨痂生长评分及骨折愈合时间两组比较差异均无统计学意义(P>0.05)。术后并发症发生率及末次随访时疼痛VAS评分、AOFAS踝-后足评分观察组均优于对照组(P<0.05)。结论跗骨窦切口钢板内固定与撬拨复位空心钉内固定均能有效治疗SandersⅡ型跟骨骨折,但撬拨复位空心钉内固定能进一步减少术中出血量,缩短手术时间及住院时间,减轻术后的疼痛,减少术后并发症的发生,更利于患者功能的恢复。Objective To compare the therapeutic effects of tarsal sinus incision plate internal fixation and prying reduction cannulated screw internal fixation on Sanders typeⅡcalcaneal fractures.Methods Sixty patients with Sanders typeⅡcalcaneal fractures were divided into an observation group(treated with prying reduction and cannulated screw internal fixation,30 cases)and a control group(treated with tarsal sinus incision and plate internal fixation,30 cases)using the random number table method.Perioperative indicators,postoperative complications incidence,ankle range of motion,fracture healing,pain VAS,and imaging indicators were compared between two groups.The therapeutic effect was evaluated by using AOFAS ankle-hindfoot score.Results All patients were followed up for 12 months after surgery.The observation group had fewer(shorter)intraoperative bleeding,surgery time,and hospital stay,compared to the control group(P<0.01).At 1 month postoperation,the two groups of Gissane angle,Bohler angle,and calcaneal width and height were all better than before surgery(P<0.05).At the last follow-up,the ankle range of motion in both groups was greater than that 1 month after operation(P<0.05).As time went on,the callus growth scores of both groups were gradually increased(P<0.05).There were no statistical differences in callus growth score at 1,2,3 months and fracture healing time between the two groups(P>0.05).The observation group was better than the control group in the terms of the incidence of postoperative complications,the pain VAS and AOFAS ankle-hindfoot score at the last follow-up(P<0.05).Conclusions Both tarsal sinus incision plate internal fixation and prying reduction cannulated screw internal fixation can effectively treat Sanders typeⅡcalcaneal fractures.However,prying reduction cannulated screw internal fixation can further reduce intraoperative bleeding,shorten surgical and hospitalization time,alleviate postoperative pain,reduce the occurrence of postoperative complications,which is more conducive to the fu

关 键 词：跗骨窦切口 钢板内固定 撬拨复位空心钉内固定 SandersⅡ型跟骨骨折 Gissane角 Böhler角 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]