手法整复配合小夹板固定治疗SandersⅠ、Ⅱ型跟骨骨折的临床研究

Clinical Research on Manipulation Reduction Combined with Small Splint Fixation in Sanders Type Ⅰ and Ⅱ Calcaneal Fractures Patients

目的：对比正骨手法整复和小夹板固定、单纯小夹板固定治疗SandersⅠ、Ⅱ型跟骨骨折的临床效果。方法：选择本院2014年6月—2016年6月收治的SandersⅠ、Ⅱ型跟骨骨折100例,随机分为两组,每组50例,试验组为正骨手法整复配合小夹板固定,对照组采用小夹板固定。分析两组患者的临床资料,观察两组治疗前、治疗后1天、治疗后2周、治疗后6周、治疗后18周的跟骨横径宽度变化、Maryland评分、VAS评分以及骨折愈合情况。结果：治疗前两组的性别比、年龄、骨折Sanders分型、骨折至治疗时间、跟骨横径宽度、VAS评分、Maryland评分均无统计学差异（P〉0.05）。入组患者在第18周复查时均达到骨折愈合标准。两组在治疗后18周的跟骨横径、Maryland评分、VAS评分较治疗前均有不同程度改善,有统计学意义（P〈0.05）。其中试验组的跟骨横径均值低于对照组,有统计学意义（P〈0.05）;在Maryland评分方面,试验组高于对照组,差异有统计学意义（P〈0.05）;但在VAS评分方面,治疗后18周两组组间对比无统计学差异（P〉0.05）;治疗后18周试验组的优良率为90.0%,对照组优良率为68.0%（P〈0.05）。结论：手法整复配合小夹板固定治疗SandersⅠ-Ⅱ型跟骨骨折可恢复跟骨横径,改善Maryland足功能评分,缓解患者疼痛症状,在疗效方面具有一定优势,并发症较少,值得推广。

Objective：To observe and compare the clinical effects of the manipulation reduction combined with small splint fixation and only mall splint fixation for the treatment of Sanders Type Ⅰand Ⅱ calcaneal fractures. Methods：A total of 100 patients of Sanders Type Ⅰand Ⅱ calcaneal fractures were enrolled in Foshan Hospital of TCM during June 2014 to June 2016. They were randomly divided into 2 groups. The experimental group was treated with manipulation reduction and small splint fixation,while the control group was simply treated with small splint fixation. Demographic information of 2 groups was analyzed,such as the situation of fracture healing,the changes of transverse diameters of calcaneus,Maryland foot scores and VAS scores before and 1 day,2,6 and18 weeks after treatments. Results：Before treatment,the difference between 2 groups was not statistically significant in the sex ratio,age,Sanders classification of fracture,treatment time,transverse diameters of calcaneus,VAS scores or Maryland scores（P〉0.05）. The X-ray films showed all the fractures united 18 weeks after treatments. The transverse diameters of calcaneus,Maryland foot scores and VAS scores of both were improved 18 weeks after treatments（ P〈0.05）. 18 weeks after treatments,the transverse diameters of calcaneusand Maryland scores of experimental group was better than those of the control group（ P〈0.05）. But the difference between 2 groups was not statistically significant in VAS scores 18 weeks after treatment（ P〉0.05）.The experimental group showed a better excellent and good rate（90. 0% versus 68. 0%,P〈0.05）. Conclusion：The combination of manipulation reduction and small splint fixation may be helpful in restoring transverse diameters of calcaneus,improving Maryland foot function scores,relieving symptom of pain for the patients of Sanders typeⅠand Ⅱcalcaneal fractures. With good clinical outcomes and less complications,the combination could be taken into consideration by the clinicians.