钢板与克氏针内固定修复跟骨骨折:Gissane角及Bohler角与跟骨高度比较

Internal fixation with plate and Kirschner wire to repair calcaneal fractures:comparison of Gissane angle, Bohler angle and calcaneus height

背景:目前对于经皮撬拨复位克氏针固定与切开复位重建钢板内固定对于跟骨关节骨折长期预后的影响仍然存在一定争议,经皮撬拨复位克氏针固定是一种创伤较小且简便的跟骨骨折修复方法,但是克氏针固定效果并不佳,需要联合外固定治疗,因此严重限制了患者早期活动以及负重行走。目的:对比分析切开复位重建钢板内固定与经皮撬拨复位克氏针固定修复跟骨关节骨折的预后效果。方法:选择2012年3月至2013年9月唐山市丰南区医院收治的跟骨关节骨折患者62例,根据修复方案分为两组,切开复位重建钢板内固定组29例,经皮撬拨复位克氏针固定组33例。对比切开复位重建钢板内固定组与经皮撬拨复位克氏针固定组Gissane角、Bohler角、跟骨高度、治疗后并发症发生率及治疗后1年随访足踝功能AOFAS评分的差异。结果与结论:切开复位重建钢板内固定组治疗后的Gissane角、Bohler角及跟骨高度显著大于经皮撬拨复位克氏针固定组(P<0.05);两组治疗后并发症发生率差异无显著性意义(P>0.05);切开复位重建钢板内固定组治疗后1年随访的足踝功能AOFAS评分显著高于经皮撬拨复位克氏针固定组(P<0.05)。提示切开复位重建钢板内固定能够恢复跟骨及距下关节的正常解剖结构,术者操作熟练可以确保手术安全性,对于跟骨骨折预后改善明显,优于经皮撬拨复位克氏针固定。

BACKGROUND：Effects of percutaneous poking fixation with Kirschner wire and open reduction and internal fixation for long-term prognosis of calcaneal fractures are controversial. Percutaneous poking fixation with Kirschner wire is a simple method with smal trauma to repair calcaneal fractures. However, the effect of fixation with Kirschner wire is poor, and external fixation is needed. Thus, it severely limits early activities and weight-bearing walking in patients. OBJECTIVE：To compare and analyze the prognosis effect of open reduction and internal fixation and percutaneous poking fixation with Kirschner wire for calcaneal fractures. METHODS：A total of 62 patients with calcaneal fractures, who were treated in Tangshan Fengnan District Hospital from March 2012 to September 2013, were selected for this study. The patients were divided into two groups according to the therapy strategy：open reduction and internal fixation group （n=29） and percutaneous poking fixation with Kirschner wire group （n=33）. Gissane angle, Bohler angle, calcaneus height, incidence of＆nbsp;postoperative complication and AOFAS score （1-year fol ow-up） were compared between the two groups. RESULTS AND CONCLUSION：The Gissane angle, Bohler angle and calcaneus height in open reduction and internal fixation group were higher than percutaneous poking fixation with Kirschner wire group （P0.05）. The AOFAS score during 1-year fol ow-up was significantly higher in open reduction and internal fixation group than in the percutaneous poking fixation with Kirschner wire group （P〈0.05）. Results indicated that open reduction and internal fixation could recover the regular structure of calcaneus and subtalar joint. Surgeon with skil ed operation skil s could ensure the safety of surgery. Open reduction and internal fixation can promote the prognosis of calcaneal fractures, and is better than percutaneous poking fixation with Kirschner wire.