钢针经皮撬拨复位与开放复位钢板内固定治疗SandersⅢ～Ⅳ型跟骨骨折疗效比较

Comparison of clinical effect between percutaneous poking fixation with kirschner wire and open reduction internal fixation with plate in treatment of SandersⅢ～Ⅳ calcaneal fractures

目的比较钢针经皮撬拔复位内固定和开放复位钢板内固定治疗SandersⅢ～Ⅳ型跟骨骨折的疗效。方法分析我院2007年12月-2012年12月收治SandersⅢ～Ⅳ型跟骨骨折30例，分别接受钢针经皮撬拨复位内固定15例（撬拨组），开放复位钢板内固定15例（切开组），观察2组的疗效及手术前后相关角度复位情况并进行比较。结果本组30例患者均获得随访，随访6月～54个月（平均18．5个月），按照Maryland足部评分系统评价术后功能，切开组明显优于撬拨组。表现在Bohler角、Gissane角和足部功能的恢复具有显著性差异（P〈0．05）。结论开放复位钢板内固定能更好地恢复跟骨的解剖结构，如能较好掌握手术适应症，精细操作，开放复位内固定不失为一种治疗SandersⅢ～Ⅳ型跟骨骨折的更好方法。

Objective To explore the clinical effect between percutaneous poking fixation with kirschner wire and open re- duction internal fixation（ORIF） with plate in treatment of Sanders m - IV calcaneal fracture. Methods The operation and fol- low-up data of 30 cases of SandersⅢ～Ⅳ calcaneal fracture between December 2007 and December 2012 were retrospectively analyzed. 30 patients with calcaneal fracture were divided into two groups, who were treated with percutaneous poking fixation and ORIF respectively and were compared as for their healing effects and operation indexes. Results All the 30 cases were followed up for 6 -54 months （ averagel8.5 months）. According to Maryland foot scores, the rates of excellent and good of the two groups were 60.0% and 93.3% respectively. Open reduction group was significantly better than percutaneous poking fixa- tion group. There was significant difference on the recovery of foot function （ P 〈 0.05 ）, Bohler angle （ P 〈 0.01 ）, and Gissane angle （ P 〈 0.05 ）. Conclusion ORIF has a better clinical effect. It is a more applicable surgery for treating SandersⅢ～Ⅳ calcaneal fracture.