开放性跟骨骨折后距下关节僵硬的预后相关因素和防治措施研究

Study on factors prognosis and control measures in subtalar joint stiffness after open calcaneal fractures

目的探索开放性跟骨骨折后距下关节僵硬的预后相关因素并提出防治措施。方法本研究选取2015年5月—2017年10月于商丘市第一人民医院治疗的62例Sanders CT分型为Ⅰ型和Ⅱ型的开放性跟骨骨折患者作为本研究的研究对象。比较开放性跟骨骨折患者行距下关节松解术术前及术后跟骨内翻角度、外翻角度、背伸角度、踝关节跖屈、后足功能以及运动疼痛模拟评分;采用logistic回归分析开放性跟骨骨折后距下关节僵硬的预后相关因素。结果患者行距下关节松解术术前与术后6个月间跟骨内翻角度、外翻角度、后足功能以及疼痛视觉模拟评分存在显著差异(P<0.05);患者行距下关节松解术术前与术后6个月间踝关节跖屈不存在显著差异(P>0.05);患者行距下关节松解术术后6个月与术后12个月间各项指标均不存在显著差异(P>0.05)。结论开放性跟骨骨折后距下关节僵硬的预后与患者术前血钙、麻醉方式、中药使用相关;距下关节松解手术能够有效治疗Sanders CT分型为Ⅰ型和Ⅱ型的开放性跟骨骨折导致的距下关节僵硬,能够改善患者的保留关节活动度,使得患者的生活质量得到显著提高。

Objective To investigate the factors prognosis and control measures in subtalar joint stiffness after open calcaneal fractures.Methods Totally 62 cases of open calcaneal fractures patients were selected,who were admitted in the our hospital between May 2015 and October 2017.Compared the bone fracture malunion Sanders CT classificationⅠtype andⅡtype who were treated by subtalar joint release surgery preoperative and postoperative calcaneal varus and valgus Angle,Angle of ankle plantar flexion,back stretch,hind AOFAS function score and analogue scale pain,observed the postoperative follow-up results.Results There were statistical differences between preoperation and 6 months postoperation on calcaneal varus and valgus angulation,AOFAS function scores and VAS scores(P<0.05);There was no significant difference in ankle plantar flexion between preoperative and postoperative 6 months(P>0.05).There was no significant difference between the 6 months after operation and the 12 months after operation(P>0.05).Conclusion Subtalar joint release operation can treat ankle and subtalar joint stiffness caused by malunion Sanders CT typing of type I or II calcaneal fracture effectively.It can improve patient retention of joint mobility,making the quality of life of patients was significantly improved.