两种手术治疗Sanders Ⅱ型、Ⅲ型跟骨骨折的比较

Comparison and Analysis of Two Surgical Methods in Treatment of Sanders Ⅱ、Ⅲ Type Calcaneal Fracture

目的比较经皮撬拨复位空心螺钉内固定与切开复位钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的临床疗效,进一步探究两种手术方式的优缺点,拓展临床医师对于跟骨骨折治疗的临床思路,为科学选择手术方案提供一定的经验和参考。方法将纳入研究的2011年10月至2012年9月间56例跟骨新鲜骨折分为A、B两组:A组即经皮撬拨复位空心螺钉内固定组(撬拨组,28例),B组即切开复位钢板内固定组(切开组,28例),比较两组患者的相关观察指标:手术时间、术中出血量、切口愈合时间、住院时间、手术前后各项影像学参数、术后并发症及足部功能恢复情况(按照Maryland足部功能评分标准),而后对各项观察指标的数据进行统计学分析,以a=0.05为检验水准,P<0.05为差异有统计学意义。结果 56例患者均获12个月随访,两组的手术时间、术中出血量、切口愈合时间、住院时间差异有统计学意义(P<0.05);术后两组间Bolher角及Gissane角及足部功能恢复优良率差异无统计学意义(P>0.05),两组术后影像学参数较术前有明显好转(P<0.05);撬拨组足部功能评分及优良率稍高于切开组,但差异无统计学意义(P>0.05),2组并发症发生率差异有统计学意义(P<0.05)。结论微创经皮撬拨复位空心螺钉内固定治疗跟骨骨折(SandersⅡ型、Ⅲ型)同样可获得良好的复位和可靠的固定,而且术中出血和术后并发症少,手术时间、切口愈合时间及住院时间较短,是治疗跟骨骨折可靠、有效、实用的手术方式。

Objective Tocompareclinicalefficacybetweenpercutaneousreductionhollowscrewinternalfixationand openreductionplateinternalfixationinthetreatmentofSandersⅡ、Ⅲtypecalcanealfracture.Methods 6casesoffreshand unilateral SandersⅡ、Ⅲ type calcaneal fractures from October 2011 to September 2012 were divided into group A and group B. Both group has 28 cases. The cases of group A were treated with percutaneous reduction and hollow screw internal fixation, and the cases of group B were treated with open reduction and plate internal fixation. We compared the two groups of patients with correlated observation index：operation time,intraoperative blood loss,incision healing time,hospitalization time after oper-ation,the imaging parameters before and after operation,the postoperative complications and the functional recovery of foot, whichwasevaluatedbyMarylandscore.Thenthedataofobservedindexeswerestatisticallyanalyzed.Results 56patients had been followed up for 12 months,significant difference could be found between operation time,peri-operative bleeding, wound healing time and hospitalization time;postoperative Bolher angle. Gissane angle and the excellent rate of functional re-covery between the two groups had no significant difference（P﹥0. 05）,two groups of postoperative radiographic parameters had obviously improved than that before operation（P﹤0. 05）;the group A was slightly higher than the group B in Maryland score and the excellent rate of functional recovery,but the difference was not statistically significant（P﹥0. 05）. There were significantdifferencesbetweenthetwogroupsinthecomplicationincidence（P﹤0.05）.Conclusion Minimallyinvasiveper-cutaneous reduction and hollow screw internal fixation for the treatment of SandersⅡ、Ⅲ type calcaneal fracture also can ob-tain good reduction and reliable fixation,and can not only lower intraoperative bleeding and postoperative complications,but can also shorten operation time,wound healing time and hospitalization time. So it is a reliable,effective and practical operation technology in the treatment of calcaneal fracture.