切开复位内固定术与经皮闭合复位微创内固定术治疗跟骨骨折的临床疗效对比

Open reduction and internal fixation versus closed percutaneous reduction and internal fixation in the treatment of calcaneal fractures

目的对比评价切开复位内固定术与经皮闭合复位微创内固定术在跟骨骨折患者手术治疗中的临床效果。方法选取2015年1月-2017年12月因Sanders II^IV型跟骨骨折就诊于苏州工业园区星湖医院进行手术治疗的149例患者作为研究对象。采用随机数字法将患者分为切开组(84例)与闭合组(65例),切开组采用切开复位内固定术,闭合组采用经皮闭合复位微创内固定术。记录两组患者手术时间、术中出血量、住院时间以及手术相关并发症。手术后进行X线检查,测量Gissane角与Bohler角并明确骨折愈合时间。采用视觉模拟法(visual analog scale,VAS)、AOFAS踝-后足评分系统(ankle hindfoot scale,AOFAS)评价足部功能恢复情况,采用健康调查量表36(short form 36,SF-36)评价患者术后生活质量。结果149例患者顺利完成手术,均未出现术中大出血、神经损伤、围术期死亡等严重情况。切开组平均随访(16.17±2.84)个月,闭合组平均随访(15.24±3.12)个月。闭合组手术时间、术中出血量、住院时间均显著低于切开组(P<0.05),切开组手术后出现切口裂开患者为4例,切口感染患者为3例,皮缘浅表坏死患者为5例,而闭合组未出现上述情况出现;切开组术后骨折愈合时间长于闭合组,但Gissane角与Bohler角度优于闭合组(P<0.05);闭合组术后1个月VAS评分优于切开组(P<0.05),但两组患者术后12个月的VAS评分差异无统计学意义(P>0.05);两组患者术后1个月的AOFAS评分差异无统计学意义(P>0.05),但12个月的AOFAS评分切开组优于闭合组(P<0.05),并且切开组术后1个月、12个月的SF-36评分均优于闭合组(P<0.05)。结论切开复位内固定具有相对较好的疗效,适用于分离严重或关节面塌陷的病例,但具有较高的并发症风险。而经皮闭合复位内固定具有创伤微小,并发症少,恢复快的特点,可主要用于软组织挫伤严重的病例,临床应根据患者实际情况选择合适手术方式。

Objective To compare and evaluate the clinical effects of open reduction and internal fixation and percutaneous closed reduction and internal fixation in the surgical treatment of calcaneal fracture with displacement.MethodsA total of 149 patients were selected as subjects with Sanders II type IV calcaneal fracture in Xinghu Hospital of Suzhou Industrial Park from January 2015 to December 2017.84 patients received open reduction and internal fixation(incision group)and 65 patients received percutaneous closed reduction and internal fixation(closed group).Recorded were the operation time,intraoperative bleeding,hospital stay and operation-related complications of the two groups.X-ray examination was performed after operation,the Gissane angle and Bohler angle were measured and the fracture healing time was determined.The recovery of foot function was evaluated by VAS score and AOFAS score,and the postoperative quality of life was evaluated by concise health status SF-36 scale.ResultsAll the 149 patients got through the operation successfully,and there were no serious cases such as intraoperative hemorrhage,nerve injury,perioperative death and the like.The average follow-up time was(16.17±2.84)months in the incision group and(15.24±3.12)months in the closure group.The operative time,intraoperative bleeding and hospital stay in the closed group were significantly lower than those in the open group(P<0.05).There were 4 cases of incision dehiscence,3 cases of incision infection and 5 cases of superficial necrosis of the skin margin in the open group,but the fracture healing time in the open group was longer than that in the closed group,but the Gissane′s angle and Bohler′s angle were better than those in the closed group(P<0.05).The VAS score of the closure group was better than that of the incision group at 1 month after operation(P<0.05),but there was no significant difference observed in VAS score between the two groups at 12 months after operation(P>0.05).Nor was there significant difference in AOFAS score between the two groups at 1 month after operation(P>0.05),but the AOFAS score at 12 months in the incision group was better than that in the closure group(P<0.05),and the SF-36 score at 12 months after operation in the incision group was better than that in the closure group(P<0.05).ConclusionOpen reduction and internal fixation were shown to have a relatively good long-term effect and were suitable for patients with severe separation or articular surface collapse,but it has a higher risk of complications.Percutaneous closed reduction and internal fixation have the characteristics of minimal trauma,few complications and rapid recovery.it can be mainly used in severe cases of soft tissue contusion,and the appropriate operation method should be chosen according to the actual situation of the patients.