撬拨复位微创置板内固定术治疗跟骨骨折的临床观察

Clinical Analysis of Treatment of Calcaneal Fractures With Percutaneous Reduction by Leverage Combined With Minimally Invasive Internal Fixation

目的:观察撬拨复位微创置板内固定术治疗SandersⅡ,Ⅲ型跟骨骨折的临床疗效。方法:选取2016年1月至2019年1月SandersⅡ,Ⅲ型跟骨骨折患者共50例,其中SandersⅡ型26例(A组),SandersⅢ型24例(B组),均采用闭合撬拨复位微创置板内固定治疗。按足部功能评分(AOFAS评分)系统评价术后6个月(或末次随访)的临床疗效,对比分析患者术前、术后第1天及术后6个月(或末次随访)的B?hler角及Gissane角,统计手术并发症。结果:50例患者均获得随访,随访时间5~7个月,平均(6.0±0.2)个月。末次随访AOFAS评分A组为88.5±8.6,B组为89.4±9.1,差异无统计学意义(P>0.05),总评分为89.2±8.9。优良率:A组为92.3%,B组为95.8%,差异有统计学意义(P>0.05),总优良率94.0%。两组术后第1天及术后6个月(或末次随访)B?hler角及Gissane角均较术前明显改善,差异有统计学意义(P<0.05),术后6个月较术后第1天B?hler角及Gissane角均有不同程度的丢失,但差异无统计学意义(P>0.05);术后第1天A组B?hler角及Gissane角均优于B组,差异有统计学意义(P<0.05)。A组并发症发生率为11.5%,B组为12.5%,差异无统计学意义(P>0.05),总发生率为12%。结论:对于粉碎程度重、移位明显的SandersⅢ型跟骨骨折,运用撬拨复位微创置板内固定可取得与SandersⅡ型一样满意的临床疗效,虽然Ⅱ型骨折较Ⅲ型骨折术后角度改善更好,但其优良率和并发症差异并无统计学意义。

Objective:To observe and analyze the clinical efficacy of percutaneous reduction by leverage combined with minimally invasive internal fixation in treating Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods:From January 2016 to January 2019,50 patients with type Ⅱ and Ⅲ calcaneal fractures in the second department of orthopaedics of Shantou Hospital of Traditional Chinese Medicine were selected. There were 26 cases of Sanders type Ⅱ(group A) and 24 cases of Sanders type Ⅲ(group B). All patients were treated with percutaneous reduction by leverage combined with minimally invasive internal fixation. The clinical efficacy of 6 months after operation(or the last follow-up) was systematically evaluated according to the American Orthopedic Foot and Ankle Society(AOFAS) score.The B?hler angle and Gissane angle of the patients before operation,the first day after operation and 6 months after operation(or the last follow-up) were compared and analyzed,and the complications of the operation were documented. Results:All 50 patients were followed up for 5 to 7 months with average of 6 months. The score:AOFAS score of the last follow-up in group A was 88.5±8.6 and group B was 89.4±9.1(P>0.05),and the total score was 89.2±8.9;the excellent and good rate was 92.3% in group A and 95.8% in group B(P>0.05),and the excellent and good rate was 94.0%. The angle:the angle of the two groups was significantly improved(P<0.05) 1 d and 6 months after the operation(or the last follow-up). Compared with B?hler angle and Gissane angle of the first day after operation,they were lost in different degrees at 6 months later,but there was no significant difference(P>0.05). B?hler angle and Gissane angle in group A on the first day after operation were better than those in group B(P<0.05). Complications:the complication rate of group A was 11.5%,12.5% in group B(P>0.05),and the total incidence was 12%. Conclusion:For severely crushed,displaced Sanders Ⅲ calcaneus fractures,the treatment of Sanders Ⅱ and Ⅲ calcaneus fractures with percutaneous reduction by leverage combined with minimally invasive internal fixation is satisfied. Although the postoperative angle of type Ⅱ fracture is better than that of type Ⅲ fracture,there is no significant difference in the excellent,good rate and complication.