微创治疗跟骨关节内骨折疗效分析

Clinical analysis on the treatment of calcaneal intraarticular fracture with minimally invasive method

【目的】探讨微创治疗跟骨关节内骨折的临床疗效。【方法】回顾性分析我科2003年1月至2010年6月间手术治疗跟骨关节内骨折122例的临床资料,其中应用微创治疗59例,应用切开复位钛板内固定术63例。【结果】患者随访6个月～4年,平均23.7月,微创组手术时间为伤后2 h至7 d,平均1.4 d,手术用时平均为48.8 min,术后无感染病例。切开复位钛板内固定组手术时间为伤后2 h至术后15 d,平均6.5 d,手术用时平均为108.6 min,术后5例出现切口感染,其中1例出现皮瓣坏化,1例进展为骨髓炎。微创组预后总优良率81.4%;切开复位内固定组预后总优良率84.1%,两组优良率无统计学差异(P>0.05),但术前平均天数及手术用时微创组明显少于切开复位内固定组,差别具有统计学意义(P<0.01)。【结论】斯氏针经皮撬拔结合有限切开复位,克氏针与空心钉内固定与切开复位钛板内固定相比,具有相类似的效果,而且具有操作简便,微创,感染风险小,可早期手术等优点,是治疗跟骨关节内骨折的理想方法。

[Objective] To evaluate the clinical effect of the treatment of calcaneal intraarticular fracture with minimally invasive method. [ Methods] The clinical data from 122 cases with calcaneal intraarticular fracture, treated in our hospital from Jan 2003 to Jun 2010, were analyzed retrospectively. Among them, 59 cases received operations with minimally invasive method, and 63 received open reduction and fixation with titanic plate. [ Results] 122 patients had been followed up for 6 ~ 48 months, an average of 23.7 months. 59 fractures in group of minimally invasion were operated after 2 hours to 7 days after trauma, an average of 6.5 days, the average time of operation was 48.8 minutes, no infection was observed. 63 fractures in group of open reduction and fixation were operated after 2 hours to 15 days after trauma, an average of 1.4 days, the average time of operation was 108.6 minutes. 5 cases with infection were observed, among them,one evolved skin necrosis and 1 osteomyelitis. According to Maryland＇s evaluation criterion, in minimally invasive treatment group, the function of joint was excellent in 20 cases, good in 28, fair in 7 and poor in 4, the total fineness ratio was 81.4% and 84.1% in open reduction and fixation group with 23 excellent, 30 good, 7 fair and 3 poor, there was not statistically difference （P〉 0.05）. But for the average time of preoperation and operation the different were significant （P〈 0.01）. [Conclusion] Because of the proximate curative effect and the advantages of simple operation, minimally invasion, fewer infection and earlier operation compared with open reduction and fixation, treatment of calcaneal intraarticular fracture by poking reduction with Steinmanncs pin in combination with limited open reduction and internal fixation with Kirschner wire and cannulated screws is a perfect method.