斯氏针撬拨复位外固定架固定治疗粉碎性跟骨骨折的疗效分析

Curative effect of prying reduction and external fixator in treatment of comminuted calcaneal fractures

目的探讨斯氏针撬拨复位外固定架固定治疗粉碎性跟骨骨折的疗效。方法笔者自2013-01—2014-06共诊治粉碎性跟骨骨折48例(57足),入院后均采用斯氏针撬拨复位外固定架进行治疗。结果 48例均获得随访6~18个月,平均12个月。Bohler角术前-20.6°~23.3°(7.5±12.1)°,拆除外固定架后24.6°~34.3°(27.5±7.3)°,Gissane角术前138.6°~167.3°(154.5±8.1)°,拆除外固定架后107.6°~144.3°(127.5±13.2)°;术后Bohler角、Gissane角均较术前有较大改善,差异有统计学意义(t=1.023,P=0.036;t=0.809,P=0.027)。末次随访时疗效根据美国足踝外科学会(AOFAS)踝与后足评分系统评定:71~96(81.65±5.23)分,优39例,良7例,可2例,优良率95.8%。未发生钉道感染、斯氏针滑脱、断钉等现象,6例术后发生创伤性关节炎,经非甾体药物治疗后症状得到明显缓解。结论斯氏针撬拨复位外固定架固定治疗粉碎性跟骨骨折既可获得满意的复位,又可避免传统大切口所造成的切口感染、皮瓣坏死等严重并发症的发生,是治疗粉碎性跟骨骨折的一种有效方法。

Objective To investigate the effect of prying reduction and external fixator in the treatment of comminuted calcaneal fractures. Methods From January 2013 to June 2014, 48 patients（57 feet） with comminuted calcaneal fractures underwent prying reduction and external fixator. Results All 48 cases were followed up for 6 to18 months, the mean period was 12 months. Bohler Angle was-20.6°-23.3°（7.5 ±12.1）° preoperatively, and 24.6°-34.3°（27.5 ±7.3）° after removal of external fixator, Gissane Angle was 138.6°-167.3°（154.5±8.1）° preoperatively and 107.6°-144.3°（127.5±13.2）° after removal of external fixator; Bohler angle, angle of Gissane were much improved after operation, the difference was statistically significant（t =1.023, P =0.036; t =0.809, P =0.027）. Evaluated according to the American society for ankle surgery（AOFAS）ankle and foot scoring system at the last follow-up： 71-96（81.65-5.23）points, 39 cases were excellent, 7 cases good, 2 cases fair. No nail infection occurred. There was no patient with Steinmann pin slipping or snapping, and there were six cases of traumatic after surgery, while the symptoms were significantly relieved after the treatment of non-steroidal anti-inflammatory drugs. Conclusion Prying reduction and external fixator in the treatment of comminuted calcaneal fractures can obtain satisfactory reduction, and can avoid traditional large incision wound infection and skin flap necrosis caused by the occurrence of serious complications. It is effective in the clinical treatment of comminuted calcaneal fractures.