跟骨移位性关节内骨折患者行切开复位内固定术治疗效果的影响因素与对策研究

Influencing factors and countermeasures of open reduction and internal fixation for displaced intraarticular calcaneal fractures

目的探究跟骨移位性关节内骨折切开复位内固定术治疗效果的影响因素以及对策。方法 56例跟骨移位性关节内骨折患者,均行切开复位内固定术治疗。观察治疗效果,分析治疗效果影响因素。结果术后,患者Bohler角、Gissane角、关节面移位距离、跟骨高、跟骨长、跟骨宽均优于术前,差异具有统计学意义(P<0.05)。56例患者手术效果优48例,差8例。单因素分析显示:不同Sanders分型、关节面移位距离、受伤到手术治疗时间、年龄、术后Bohler角患者治疗效果优率比较差异具有统计学意义(P<0.05)。Logistic回归分析显示:术后Bohler角、Sanders分型是影响治疗效果的独立危险因素。结论影响跟骨移位性关节内骨折切开复位内固定术治疗效果的独立危险因素为术后Bohler角、Sanders分型,术中重点对存在的影响因素进行处理,可有效提升治疗效果。

Objective To investigate the influencing factors and countermeasures of open reduction and internal fixation for displaced intra-articular calcaneal fractures. Methods A total of 56 patients with displaced intra-articular calcaneal fractures were treated with open reduction and internal fixation. The treatment effect was observed and the influencing factors of treatment effect was analyzed. Results After operation, patients had better Bohler angle, Gissane angle, displacement distance of articular surface, calcaneal height, calcaneal length, calcaneal width than those before operation, and their difference was statistically significant (P<0.05). In 56 patients, there were 48 cases with good surgical results and 8 cases with poor results. Univariate analysis showed that there were significant differences in Sanders classification, displacement distance of articular surface, time from injury to operation, age, and the excellent rate of treatment in patients with postoperative Bohler angle (P<0.05). Logistic regression analysis showed that postoperative Bohler angle and Sanders classification were independent risk factors affecting the treatment effect. Conclusion The independent risk factors affecting the outcome of open reduction and internal fixation for displaced intra-articular calcaneal fractures were postoperative Bohler angle and Sanders classification. Emphasis should be placed on dealing with the influencing factors during the operation, thus effectively improving the treatment effect.