经皮撬拨复位克氏针内固定和切开复位钢板内固定治疗SandersⅡ型跟骨骨折的效果对比

Comparison of percutaneous pry reduction and Kirschner wire internal fixation with open reduction and plate internal fixation for Sanders type Ⅱ calcaneal fractures

目的研究比较经皮撬拨复位克氏针内固定和切开复位钢板内固定治疗SandersⅡ型跟骨骨折的效果。方法选择2015年3月～2017年12月于我院住院接受治疗的160例SandersⅡ型跟骨骨折患者,根据其接受的手术治疗方式,分为对照组和观察组各80例,对照组为采用切开复位钢板内固定术治疗,观察组为采用经皮撬拨复位克氏针内固定术治疗。回顾性分析两组患者手术时间、术中出血量、住院时间、骨折愈合时间、踝-后足量表评分(AOFAS)、手术前后跟骨结节关切角(Bohler角)、跟骨交叉角(Gissane角)、跟骨中部宽度以及术后并发症等临床资料。结果观察组在手术时间、术中出血量、术后住院时间上都明显低于对照组,差异有统计学意义(P <0.01);两组患者在术后骨折愈合时间以及评价预后质量的AOFAS评分上差异无统计学意义(P> 0.05);观察组与对照组相比较,两组患者手术前以及手术后Bohler角、Gissane角和跟骨中部宽度相比较差异无统计学意义(P>0.05)。组内比较,两组患者经过治疗后,Bohler角、Gissane角和跟骨中部宽度均高于治疗前,差异具有统计学意义(P均<0.05);对照组患者并发症总发生率明显高于观察组,差异具有统计学意义(P <0.01)。结论在明确手术适应症前提,运用经皮撬拨复位克氏针内固定术治疗SandersⅡ型跟骨骨折比传统切开复位钢板内固定术具有简便手术、减少切口创伤以及术后皮肤感染的优势,临床上应当作为首选术式。

Objective To study and compare the effect of percutaneous prying reduction and Kirschner wire internal fixation and open reduction and plate internal fixation for Sanders type Ⅱ calcaneal fractures. Methods One hundred and sixty patients with Sanders type Ⅱ calcaneal fractures treated in our hospital fi＇om March 2015 to December 2017 were selected.According to the way of surgical treatment,they were divided into the control group and the observation group,80 cases in each group.The control group was treated with open reduction and internal fixation.The observation group was treated by percutaneous prying reduction and internal fixation with Kirschner wire.The operative time,intraoperative bleeding volume,hospital stay,fracture healing time,ankle-hind foot scale score （AOFAS）,calcaneal tubercle concern angle （Bohler angle） calcaneal cross angle （Gissane angle）, middle calcaneal width and postoperative complications were analyzed retrospectively. Results The operation time,intraoperative bleeding volume and postoperative hospitalization time of the observation group were significantly lower than those of the control group （P 〈 0.01）.There was no significant difference in AOFAS score of fracture healing time and prognostic quality between the two groups （P 〉 0.05）. There was no significant difference in Bohler angle,Gissane angle and middle calcaneal width between the two groups before and after operation （P 〉 0.05）.After treatment,Bohler angle,Gissane angle and middle calcaneal width of the two groups were higher than those before treatment,and the difference was statistically significant （P 〈 0.05）.The total incidence of complications in the control group was significantly higher than that in the observation group （P 〈 0.01）. Conclusion By precondition for indications of surgery, using Percutaneous poking reduction with Kirschner wire has the advantages in simplifying the operation,reduction of wound and postoperative skin infection than the open reduction with plate for the therapy of internal fixation of Sanders Ⅱ.It should be the first choice in clinical practice.