两种固定方法治疗跟骨骨折的疗效比较

The Effectiveness Comparative of Two Methods for the Treatment of Calcaneal Fractures

目的：比较经皮撬拨复位外固定支架固定术与切开复位解剖钢板内固定术治疗跟骨骨折的临床疗效。方法：选取本院自2010年10月-2014年7月收治的68例跟骨骨折病例,36例行经皮撬拔复位外固定支架固定术,32例行切开复位解剖钢板内固定术,比较两组临床疗效。结果：68例患者均获随访,随访时间6~18个月,平均12个月,经张铁良足部综合评分法进行评分,撬拨复位组优17例,良12例,中6例,差1例,优良率80.6%;切开复位组优17例,良9例,中5例,差1例,优良率81.3%,两组优良率比较,差异无统计学意义（P〉0.05）。两组患者术后观察,撬拨复位组手术时间短,术后针口感染2例,无皮肤缺血坏死;切开复位组术后切口感染6例,皮肤坏死2例,但在Bohler角、Gissane角及跟骨宽度方面优于撬拨复位组。结论：撬拨复位支架外固定是一种微创手术,损伤小,费用低,术后切口感染少,但支架针口外露,需定期换药处理,切开复位解剖钢板内固定损伤大,剥离广泛,有一定的切口感染及皮肤坏死的风险,两种固定方法均是治疗跟骨骨折切实可行的方法。

Objective： To compare percutaneous prying reduction and external fixation support fixation with anatomic plate internal fixation the clinical curative effect of calcaneal fractures. Method： From October 2010 to July 2014, 68 patients with calcaneal fractures in our hospital were selected, 36 cases underwent percutaneous reduction and external fixation support fixation, 32 cases underwent open reduction and anatomic plate internal fixation. Clinical curative effect between the two groups was compared. Result： 68 patients were followed up for 6 to 18 months, average of 12 months. According to the foot rating comprehensive score method, in prying reset group, 17 cases were optimal, 12 cases good, 6 cases medium, and a worse ease, excellent rate was 80.6%. In open reduction group, 17 cases were optimal, 9 cases good, 5 cases medium, and a worse case, excellent rate was 81.3%. The difference was not obvious between the two groups （ P〉0.05 ） . In the prying reset group, operation time was shorter, and 2 cases got needle mouth postoperative infection, no one skin isehemic necrosis. In the open reduction group, needle mouth postoperative infection in 6 cases, skin necrosis in 2 cases, but postoperative Bohler angle, Gissane angle and caleaneal width of open reduction was superior. Conclusion： Prying reset bracket external fixation is a kind of minimally invasive surgery, with a small injury, low cost, less postoperative incision infection, but support needle mouth exposed, the need to change medicine treatment regularly, open reduction and internal fixation with anatomic plate damage, stripping is widespread, which has the certain risk of incision infection and the skin necrosis, both two fixed methods are feasible methods for the treatment of calcaneal fractures.