经皮三维空心钉与开放钢板固定跟骨骨折比较  

Percutaneous three-dimensional cannulated screws versus open plate fixations for calcaneal fractures

作　　者：张洋 孔德海[1] 赵永杰 刘颖[1] 孙广超[1] ZHANG Yang;KONGDe-hai;ZHAO Yong-jie;LIU Ying;SUN Guang-chao(Department of Foot and Ankle Surgery,Binzhou Medical University Hospital,Binzhou,Shandong 256603,China)

机构地区：[1]滨州医学院附属医院足踝外科,山东滨州256603

出　　处：《中国矫形外科杂志》2025年第4期318-323,共6页Orthopedic Journal of China

基　　金：山东省医药卫生科技发展计划项目(编号:202104070986)。

摘　　要：[目的]探讨经皮三维空心钉与开放钢板固定治疗Sanders Ⅱ型及Ⅲ型跟骨骨折的临床疗效。[方法]回顾性分析2019年12月—2021年12月本科手术治疗的99例Sanders Ⅱ型和Ⅲ型跟骨骨折患者。根据医患沟通结果,51例采用闭合复位埋头钉三维立体髓内固定治疗(经皮组);48例采用切开复位钢板螺钉内固定治疗(开放组)。比较两组患者围手术期、随访和影像资料。[结果]经皮组手术时间[(50.2±1.8)min vs(87.6±1.8)min,P<0.001]、切口长度[(3.1±0.5)cm vs(14.3±0.4)cm,P<0.001]、术中出血量[(15.0±1.8)mL vs(164.9±1.8)mL,P<0.001]、住院时间[(4.0±0.2)d vs(9.9±0.2)d,P<0.001]均显著少于开放组,但经皮组术中透视次数[(17.1±1.9)次vs(4.9±1.8)次,P<0.001]显著多于开放组。经皮组术后下地行走时间和完全负重活动时间均显著早于开放组(P<0.05)。随时间推移,两组VAS、AOFAS评分和足内-外翻ROM均显著改善(P<0.05),术后3 d和末次随访时,经皮组VAS[(2.9±0.8)vs(5.8±1.1),P<0.001;(0.9±1.0)vs(2.0±1.0),P<0.001]、AOFAS踝-后足评分[(63.4±2.9)vs(60.6±2.6),P<0.001;(94.9±2.2)vs(91.1±2.5),P<0.001]和足内-外翻ROM[(15.4±0.6)°vs(11.7±0.7)°,P<0.001;(54.6±1.8)°vs(51.5±1.6)°,P<0.001]均显著优于开放组。影像方面,与术前相比,末次随访时两组Bohler角、Gissane角、软骨面塌陷、跟骨长度、跟骨宽度以及跟骨高度均显著改善(P<0.05),末次随访时,两组跟骨长度差异无统计学意义(P>0.05),但是,经皮组其他影像指标均显著优于开放组(P<0.05)。[结论]经皮三维空心钉髓内固定为髓内多维固定,根据跟骨应力分布设计置钉方向,更加符合跟骨的生物力学特征,可以有效固定术后跟骨的位置和正常形态,安全性更高。[Objective]To compare the clinical outcome of closed reduction and percutaneous three-dimensional cannulated screw fixation(PTDCSF)versus open reduction and plate fixation(ORPF)in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures.[Methods]A retrospective research was done on 99 patients who received surgical treatment for Sanders type Ⅱ and Ⅲ calcaneal fractures in our hospital from December 2019 to December 2021.According to the doctor-patient communication before surgery,51 patients received PTDCSF,while other 48 patients had ORPF performed.The documents regarding to perioperative period,follow-up and imaging were compared between the two groups.[Results]The PTDCSF group was significantly superior to the ORPF group in terms of surgery time[(50.2±1.8)minvs(87.6±1.8)min,P<0.001],incision length[(3.1±0.5)cm vs(14.3±0.4)cm,P<0.001],blood loss[(15.0±1.8)mL vs(164.9±1.8)mL,P<0.001],hospital stay[(4.0±0.2)days vs(9.9±0.2)days,P<0.001].However,the former had significantly greater intraoperative fluoroscopytimes than the latter[(17.1±1.9)times vs(4.9±1.8)times,P<0.001].In addition,the PTDCSF group resumed postoperative ambulation andfull weight-bearing activity significantly earlier than the ORPF group(P<0.05).The VAS,AOFAS score and inversion-eversion range ofmotion(ROM)in both groups were significantly improved over time(P<0.05).The PTDCSF group was also significantly better than the ORPF group regarding VAS score[(2.9±0.8)vs(5.8±1.1),P<0.001;(0.9±1.0)vs(2.0±1.0),P<0.001],AOFAS ankle and hindfoot score[(63.4±2.9)vs(60.6±2.6),P<0.001;(94.9±2.2)vs(91.1±2.5),P<0.001]and ROM[(15.4±0.6)°vs(11.7±0.7)°,P<0.001;(54.6±1.8)°vs(51.5±1.6)°,P<0.001]3 days after surgery and at the last follow-up.As for imaging,the B?hler angle,Gissane angle,cartilage surface collapse,calcaneus length,calcaneus width and calcaneus height were significantly improved in both groups at the last follow-up compared with those preoperatively(P<0.05).Although there was no statistical significance in calcaneus lengt

关 键 词：跟骨骨折 骨内固定 经皮空心螺钉 锁定钢板 

分 类 号：R683.42[医药卫生—骨科学]