微创撬拨复位空心拉力螺钉固定与钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的疗效分析

Analysis of curative effects by minimally invasive poking reduction cannulate lag screw and plate internal fixation in the treatment of Sanders Ⅱ and Ⅲ type calcaneal fracture

目的探讨比较微创撬拨复位空心拉力螺钉固定与钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的疗效。方法 57例（65足）SandersⅡ型、Ⅲ型跟骨骨折患者,随机分为撬拨组（给予微创撬拨复位空心拉力螺钉固定）与切开组（给予常规钢板内固定）,其中撬拨组22例（24足,Ⅱ型18足,Ⅲ型6足）,切开组35例（41足,Ⅱ型29足,Ⅲ型12足）,评价两组的治疗效果。结果 57例患者均获随访,随访时间10~18个月,撬拨组手术时间（67.52±7.56）min、术中出血量（49.32±5.24）ml、切口愈合时间（6.64±1.45）d均优于切开组（103.56±14.96）min、（123.47±19.24）ml、（13.12±1.56）d,差异有统计学意义（P〈0.05）。术后两组Bohler角、Gissane角恢复情况、并发症及术后足部功能恢复优良情况比较差异无统计学意义（P〉0.05）,切开组3例出现坏死。结论微创撬拨复位空心拉力螺钉固定治疗SandersⅡ型、Ⅲ型跟骨骨折,术中出血少、手术时间短、术后并发症少,是治疗跟骨骨折（SandersⅡ型、Ⅲ型）的有效手术方式。

Objective To investigate and compare curative effects between minimally invasive poking reduction cannulate lag screw and plate internal fixation in the treatment of Sanders Ⅱ and Ⅲ type calcaneal fracture. Methods A 57 patients（65 feet）with Sanders Ⅱ and Ⅲ type calcaneal fracture were randomly divided into poking reduction group（received minimally invasive poking reduction cannulate lag screw for fixation）and incision group（received conventional plate internal fixation）, with 22 cases in the poking reduction group（24 feet, 18 Ⅱ type feet and 6 Ⅲ type feet）and 35 cases in the incision group（41 feet, 29 Ⅱ type feet and 12 Ⅲ type feet）. Curative effects were evaluated in both groups. Results All 57 patients received follow-up for 10~18 months. The poking reduction group had operation time as（67.52±7.56）min, intraoperative bleeding volume as（49.32±5.24）ml, and incision healing time as（67.52±7.56）min, which were all better than（103.56±14.96）min,（123.47±19.24）ml and（13.12±1.56）d in the control group. Their difference had statistical significance（P〈0.05）. There was no statistically significant difference of postoperative recovery of Bohler angle, Gissane angle, complications and foot function between the two groups（P〈0.05）. There were 3 cases with necrosis in the incision group. Conclusion Minimally invasive poking reduction cannulate lag screw for fixation in treating Sanders Ⅱ and Ⅲ type calcaneal fracture shows few intraoperative bleeding volume, short operation time and few postoperative complications. It is an effective operation in treating calcaneal fracture（Sanders Ⅱ and Ⅲ type）.