Sanders Ⅱ、Ⅲ型跟骨骨折术后两种不同外固定方法疗效的比较

Comparative study on two external fixation approaches for Sanders Ⅱ,Ⅲ type calcaneal fractures

目的对比撬拨复位跟骨骨折手术后的两种固定方式：以改良外固定支具外固定和以管型石膏外固定,总结撬拨复位配合改良跟骨外固定支具治疗跟骨骨折的临床效果及数据统计,分析该治疗方法的合理性。方法选取2010年5月~2014年9月60例（60处）Sanders II、III型跟骨骨折患者,对照组和治疗组各半,两组均采取同样的手术方法,对照组术后以传统石膏外固定,而治疗组术后以改良外固定支具外固定。随访记录两组患者的Bohler角、Gissane角、跟骨宽度、Maryland评分、并发症出现机率。结果治疗后治疗组与对照组影像学分析Bohler角和Gissane角不存在明显差异（P〉0.05）。治疗后两组治疗组跟骨宽度恢复要好于对照组（P〈0.01）,术后Maryland评分对比治疗组效果好于对照组（P〈0.05）。治疗组术后并发症发生率（13.2%）要低于对照组（23.1%）。结论撬拨复位手术后以改良支具外固定治疗跟骨骨折,具有创伤小、效果佳、操作简单、治疗费用少、住院耗时短、固定稳固、便于锻炼等优势,术后患者恢复情况良好,说明该治疗方法临床效果较好,理论依据清晰。

Objective To compare the poking reduction combined with external fixation supporting instrument for calcaneus improvement with the poking reduction combined with plaster external fixation,for the purpose to discuss the treating mechanism and clinical effects of treatment on calcaneal fracture by poking reduction combined with external fixation supporting instrument for calcaneus improvement,and to explain the reasonability of the improving supporting instrument.Methods 60 cases（60 positions） of patient with calcaneal fracture from May 2010 to Sep 2014 have been selected and divided into control group and treatment group.The 30 cases（30 positions） of patient with calcaneal fracture in the control group were administrated with treatment of poking reduction combined with plaster external fixation;The 30 cases（30positions） of patient with calcaneal fracture in the treatment group were administrated with treatment of poking reduction combined with external fixation supporting instrument for calcaneus improvement.The Bohler angle,Gissane angle,Calcaneal value,Maryland-evaluation and incidence of complication of patients in both groups were recorded through follow-up visit.Results After treatment,through a statistical analysis on the imaging analysis on the Bohler angle and Gissane angle of patients in both groups,the difference between them was not found to be statistically significant（P〈0.05）.The difference in calcaneal width after treatment between two groups was found to be statistically significant by a statistical analysis（P〈0.01）,based on postoperative Maryland-evaluation and statistical rank sum test analysis,the effect of treatment group was better than control group（P〈0.05）,the incidence of postoperative complication of treatment group was 13.2% when control group was 23.1%,which shows that incidence of postoperative complication of control group was significantly higher than that of treatment group.Conclusion Treatment on calcaneal fracture by poking reduction combined with external fixation supporting instrument for calcaneus improvement has such advantages as less damage,obvious curative effects,simple operation that is easy to learn,low cost,short hospital stay,reliable reduction of fracture,firm fixation and reasonable exercise,it has an obvious effect in furthering the postoperative functional recovery.