微创撬拨治疗SandersII型跟骨骨折的疗效及C砌冰平观察

目的观察微创撬拨治疗SandersII型跟骨骨折的疗效以及患者术后血清cRP变化情况。方法选取2013年6月至2015年12月间收治的624例SandersII型跟骨骨折作为观察对象，根据治疗术式将入选患者分为对照组与观察组，对照组为采取切开复位联合内固定术治疗的31例患者，观察组为采取经皮撬拨复位联合内固定术治疗的31例患者。观察并对比两组患者的临床指标，术前及术后即刻的Bohler角度、Gissane角度以及跟骨中部的宽度三项生理解剖指标；随访12个月vRMaryland评分及AOFAS评分系统评估两组患者疗效；监测两组患者术后血清CRP表达水平以评估术后感染情况。结果观察组手术用时、术中出血量及住院时间均小于对照组（P〈0．05）；两组骨折愈合时间无明显差异（P〉0．05）。两组治疗后Bohler角、Gissane角及跟骨中部宽度均显著改善，组内对比差异均具有统计学意义（P〈0．05）；治疗前、后两组组间对比差异均无统计学意义（P〉0．05）。术后12个月两组患者的Maryland评分、AOFAS评分均无明显差异（P〉0．05）。观察组术后CRP表达水平整体水平与趋势显著低于对照组（P〈0.05）。结论微创撬拨治疗SandersII型跟骨骨折疗效可达到与切开复住相同的疗效，并且手术创口小、对周围组织的损伤小，术后CRP上升不显著，恢复快，因此可于闭合性SandersII型跟骨骨折治疗中推广应用，以减少患者痛苦、有利于术后恢复。

Objective To observe the efficacy of minimally invasive poking therapy for Sanders type II calcaneal fracture and the change of serum CRP after operation. Methods 62 cases of Sanders type fractures treated in our hospital from June 2013 to December 2015 were selected as observation objects, the patients were divided into control group and observation group according to the treatment, 31 cases of open reduction and internal fixation in the control group, 31 cases in the observation group was taken with percutaneous reduction and fixation for the treatment. The observation and clinical indexes of two groups were compared before and after the operation including immediate Bohler angle, Gissane angle and middle width of calcaneal anatomic index. The results of the two groups were evaluated by Maryland score and AOFAS scoring system for 12 months, and the level of serum CRP expression was monitored after operation in two groups of patients to assess postoperative infection. Results The time of operation, the amount of bleeding and the length of stay in the observation group were smaller than those in the control group, P〈0.05, and the fracture healing time between the two groups was not significantly different, P〉0.05. The Bohler angle, Gissane angle and the width of the middle part of the calcaneus were significantly improved in the two groups after treatment, and there was statistical difference between the two groups, P〈0.05. The difference between the two groups before and after treatment was not statisticrally significant, P〉0.05. There was no significant difference in Maryland score and AOFAS score between the two groups at 12 months after the operation, P〉0.05. The level and trend of CR.P expression in the observation group were significantly lower than that in the control group, P〈0.05. Conclusion Poking Sanders type fracture treatment effect can be reached with the same effect of open reduction and operation, small wound, little damage to the surrounding tissue, postoperative CRP increased significantly faster recovery, so it can be closed in Sanders type II calcaneal fracture treatment in the application, in order to reduce the pain of patients, conducive to postoperative recovery.