小切口与手法整复穿针内固定对Sanders Ⅳ型跟骨骨折临床观察

Clinical Observation of Small Incision Combined with Manipulative Reduction and Pinning Internal Fixation for Sanders Ⅳ Type Calcaneal Fracture

目的:观察小切口与手法整复穿针内固定治疗SandersⅣ型跟骨骨折的临床效果。方法:将SandersⅣ型跟骨骨折患者80例按随机数字表法分为2组各40例,手法组采用小切口与手法整复穿针内固定治疗,对照组采用外侧扩大"L"切口AO钢板内固定治疗,对比2组的一般手术指标、术后功能恢复情况。结果:手法组的手术时间、手术出血量、住院时间、住院费用均低于对照组,差异有统计学意义(P<0.05)。术后3月、6月,手法组的Bohlers角、Gissane角、跟骨中部宽度丢失值与对照组比较,差异无统计学意义(P>0.05)。术后6月,手法组的足踝关节功能优良率87.50%与对照组的92.50%,差异无统计学意义(P>0.05)。术后,手法组共计有关节炎2例,对照组共计有切口感染2例、关节炎2例、腓肠肌损伤3例、腓骨肌腱炎2例,手法组的并发症率5.00%低于对照组的22.50%,差异有统计学意义(P<0.05)。结论:小切口与手法整复穿针内固定治疗SandersⅣ骨折效果可靠,具有并发症少、创伤小的优点。

Objective： To observe the clinical effect of small incision combined with manipulative reduction and pinning internal fixation for Sanders IV type calcaneal fracture. Methods： Divided 80 cases of patients with Sanders IV type calcaneal fracture into two groups randomly, 40 cases in each group. The manipulation group was treated with small incision combined with manipulative reduction and pinning internal fixation, while the control group was treated with lateral expanding ＂L＂incision AO plate internal fixation. Compared general surgery indexes and recovery of function after surgery in both groups.Results： Surgery time, operative bleeding volume, hospitalization time and hospitalization expenses in the manipulation group were lower than those in the control group（P 〈 0.05）. Three months and 6 months after surgery, compared Bohlers angle,Gissane angle and central width of calcaneal in the manipulation group with those in the control group, no significance was found in differences（P 〉 0.05）. Six months after surgery,the excellent and good rate of ankle joint function was 87.5 0 % in the manipulation group and 92.50% in the control group,showing no significance in the difference（P 〉 0.05）. After surgery,2 cases of arthritis were found in the manipulation group,while 2 cases of incision infection,2 cases of arthritis,3 cases of gastrocnemius injury and 2 cases of peroneal tendonitis were found in the control group. The complication rate in the manipulation group was 5.00%,being lower than 22.50% of the control group（P 〈 0.05）. Conclusion：The therapy of small incision combined with manipulative reduction and pinning internal fixation for Sanders IV type calcaneal fracture has reliable effect with advantages of less complications and less trauma.