跟腱旁小切口克氏针内固定治疗跟骨关节内骨折

Open reduction with small incision near Achilles tendon and Kirschner wire fixation of intra-articular calcaneal fracture

目的探讨跟腱旁小切口克氏针内固定治疗跟骨骨折的临床疗效。方法手术治疗71例跟骨骨折患者(82足),其中治疗组38例(39足)给予跟腱旁小切口、交叉克氏针内固定,对照组33例(43足)给予跟骨外侧L形切口、跟骨钢板内固定。比较两组的切口愈合时间、切口并发症发生率、末次随访AOFOS评分、Bhler角改变、Gissane角改变。结果 71例均获随访,时间8～28(14.6±1.2)个月。并发症:治疗组切口延迟愈合2足;对照组切口延迟愈合3足,创缘坏死2足,浅表感染1足。治疗组的手术切口并发症明显少于对照组(P<0.05)。两组手术切口愈合时间、Bhler角及Gissane角、末次随访AOFOS评分比较,差异均无统计学意义(P>0.05)。结论跟腱旁小切口克氏针内固定治疗跟骨关节内骨折疗效肯定,切口并发症少。

Objective To investigate clinical efficacy of Kirschner wire fixation of intra-articular calcaneal fractures with small incision near the Achilles tendon. Methods 71 cases（82 feet） of calcaneal fracture were divided into two groups. The treatment group（ 39 feet） was treated by small incision near Achilles tendon and internal fixation with Kirsehner wire. The control group（43 feet） was treated by L-shaped lateral incision and internal fixation with caleaneal plate. The incision healing time, BiShler angle and Gissane angle, AOFAS score at the time of the last follow-up were measured and compared. Results 71 cases were followed up for 8 - 28 （ 14. 6 ± 1.2 ） months. Surgical wound complications in the treatment group was significantly less than the control group （P 〈 O. 05）. About complications： 2 feet in treatment group were delayed wound healing. In control group 6 feet were complicated, delayed wound healing （3 feet） , wound edge necrosis（2 feet） and superficial infection（ 1 foot）. There were no statistical differences in the wound healing time, B^hler angle and Gissane angle and the AOFAS score at the time of the last follow-up between two groups （ P 〉 0. 05 ）. Conclusions open reduction with small incision near Achilles tendon and Kirsehner wire fixation for intra-articular ealeaneal fracture has positive effect with less complications.