经皮撬拨复位克氏针固定术与切开复位钢板内固定术治疗跟骨骨折对比研究

Comparative study between percutaneous poking fixation with kirschner wire and open reduction internal fixation with plate in the treatment of calcaneal fracture

目的比较经皮撬拨复位克氏针固定术与切开复位钢板内固定术治疗跟骨骨折的临床疗效,探讨治疗跟骨骨折的有效方法。方法将92例跟骨骨折患者随机分为经皮撬拨复位克氏针组和切开复位钢板内固定组,每组46例。两组患者分别给予经皮撬拨复位克氏针固定术和切开复位钢板内固定术治疗。两组患者于术前及术后1周、术后1年行X线检查测量Bohler角、Gissane角、跟骨高度和宽度,采用Maryland足部功能评分评价临床疗效,并观察两组术后并发症情况。结果术后1周及术后1年,较术前两组Bohler角及Gissane角均增加(P<0.05),跟骨高度增加(P<0.05),跟骨宽度减小(P<0.05),但切开复位钢板内固定组较经皮撬拨复位克氏针组变化更明显(P<0.05)。与术后1周比较,经皮撬拨复位克氏针组术后1年Bohler角、Gissane角、跟骨高度减小(P<0.05),跟骨宽度增加(P<0.05);而切开复位钢板内固定组术后1年与术后1周相比,各指标变化差异无统计学意义(P>0.05)。切开复位钢板内固定组术后优良率显著高于经皮撬拨复位克氏针组(P<0.05),但并其发症发生率(13.04%,6/46)高于经皮撬拨复位克氏针组(0,0/46)(P<0.05)。结论切开复位钢板内固定术可较好地恢复跟骨骨折患者的Bohler角、Gissane角、跟骨高度和宽度,临床疗效佳,有效预防相关并发症后可成为治疗跟骨骨折的更佳术式选择。

Objective To compare the clinical efficacy between percutaneous poking fixation with kirschner wire（PPFK） and open reduction internal fixation with plate（ORIF） in the treatment of calcaneal fracture,in order to explore the effective method for calcaneal fracture treatment.Methods A total of 92 patients with calcaneal fracture were divided into PPFK group and ORIF group randomly,each group had 46 patients.The patients of the two groups underwent PPFK or ORIF treatment respectively.X-ray was done to determine Bohler angle,Gissane angle,height and width of calcaneus before surgery and 1 week,1 year after surgery of the two groups,Maryland score was done to evaluate clinical efficacy,then the complications of two groups were also observed.Results Compared with before surgery,1 week and 1 year after surgery,the Bohler angle and Gissane angle of the two groups increased（P 0.05）,height of calcaneus also increased（P 0.05）,and the width decreased（P 0.05）,and the ORIF group showed better recovery in all indexes than the PPFK group（P 0.05）.Compared with 1 week after surgery,the Bohler angle,Gissane angle and height of calcaneus of PPFK group decreased than 1 year after surgery（P 0.05）,the width of calcaneus increased（P 0.05）.But no obvious change was observed in the ORIF group.The good rate of the ORIF group was higher than that of the PPFK group（P 0.05）,but the incidence of complications（13.04%,6/46） was higher than that of the PPFK group（0,0/46）（P 0.05）.Conclusion ORIF can better recover the Bohler angle,Gissane angle,height and width of calcaneus of patients with calcaneal fracture and has better clinical effect,it can become the applicable surgery for treating calcaneal fracture if related complications are prevented effectively.