开始部分负重与完全负重功能锻炼对Sanders Ⅱ～Ⅲ型跟骨骨折切开复位内固定术后患者足部功能的影响

Study on the effect of joint function with partial and full weight-bearing functional exercise in patients with Sanders Ⅱ-Ⅲ calcaneal fractures after open reduction and internal fixation

目的研究开始部分与完全负重功能锻炼时间对SandersⅡ~Ⅲ型跟骨骨折切开复位内固定术后患者足部功能的影响。方法选取60例SandersⅡ~Ⅲ型跟骨骨折患者,随机分为对照组(n=28)和研究组(n=32)。对照组术后开始进行完全负重时间>5个月,平均完全负重时间为(5.34±1.43)个月;研究组术后1~2个月开始进行部分负重功能锻炼,于5个月内开始进行完全负重,平均时间为(3.14±1.05)个月。对比两组Maryland足部评分、B9hler角、Gissane角,以及术后并发症发生情况。结果研究组Maryland足部评分优良率高于对照组(χ~2=13.53,P=0.01)。两组患者B9hler角、Gissane角对比均无显著差异(t=2.06,1.68,P>0.05)。对照组出现2例骨髓炎,通过抗生素骨水泥填充治疗后改善,2例患者切口愈合推迟,通过换药3周后明显改善;研究组出现4例患者切口愈合推迟,通过换药3周后明显改善,两组术后并发症发生率无显著差异(χ~2=2.76,P=0.21)。结论 SandersⅡ~Ⅲ型跟骨骨折患者切开复位内固定术后5个月内开始完全负重功能锻炼对其足部功能的改善较好于开始完全负重时间超过5个月的患者。

Objective To study the effect of joint function with partial and full weight - bearing functional exercise in patients with Sanders Ⅱ - Ⅲ calcaneal fracture after open reduction and internal fixation. Methods 60 patients with Sanders Ⅱ - Ⅲ calcaneal fracture were selected and randomly divided into control group （28 cases） and study group （32 cases） , patients in control group took full weight - bearing exercise for more than 5 months after the operation, and the average full weight - bearing exercise time was （5.34 ± 1.43） months; patients in study group （32 cases） began partial weight - bearing exercise in 1.2 months after the operation and the full weight - bearing exercise for 5 months, with the average duration of 3. 14 ± 1.05 months. The Maryland foot scores, Bohler angle, Gissane angle and incidence of postoperative complications were compared between these two groups. Results The excellent and good rate of Maryland foot scores in patients of study group was higher than that in patients of control group （χ^2 = 13. 53 , P = 0.01）. The difference in Bohler angle and Gissane angle between these two groups was not significant （ t = 2.06,1.68 , P〉0.05）. Osteomyelitis occurred in 2 cases of control group and they were both improved by treatment with antibiotic bone cement reconstruction ; 2 patients had poor wound healing and they were significantly improved by dressing changes for 3 weeks. Four patients had poor wound healing in study group and they were significantly improved after dressing changes for 3 weeks. The difference in postoperative complications was not significant between these two groups （χ^2 =2.76 , P = 0. 21） . Conclusion Patients with Sanders Ⅱ - Ⅲ calcaneal fracture treated with open reduction and internal fixation and they are taking full weight - bearing functional exercise within 5 months after the operation in order to improve their foot function, and the result is better than those with delayed full weight - bearing exercise over 5 months after the operation.