小切口撬拨复位克氏针内固定术与切开复位钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效对比

Comparison of effects of small incision combined with prying reset Kirschner wire internal fixation andopen reduction plateinternal fixation in the treatment for SandersⅡandⅢType calcaneal fractures

目的研究SandersⅡ、Ⅲ型跟骨骨折患者使用小切口撬拨复位克氏针内固定术与切开复位钢板内固定术两种手术方法的治疗效果,对比两种方法临床效果及优点。方法选择2016年1月至2018年1月于我院住院接受治疗的80例SandersⅡ、Ⅲ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40例,对照组为采用切开复位钢板内固定术治疗,观察组为采用小切口撬拨复位克氏针内固定术治疗。回顾性分析两组患者术前准备时间、手术时间、术中出血量、住院时间、治疗费用、骨折愈合时间、Maryland足部评分、治疗优良率、及术后并发症等临床资料;同时分析手术前后及末次随访的Bohler角、Gissane角、跟骨中部宽度值。结果所有病例得到随访,随访时间12~16个月,平均13.3个月。观察组在术前准备时间、手术时间、术中出血量、术后住院时间、治疗费用上都低于对照组,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Maryland足部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、后及末次随访的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,差异有统计学意义(P<0.05);对照组患者并发症总发生率明显高于观察组,差异有统计学意义(P<0.01)。结论用小切口撬拨复位克氏针内固定术和切开复位钢板内固定术治疗跟骨骨折均能取得良好的疗效。但前者具有操作简单、创伤小、费用低、并发症少等优点。

Objective To study the therapeutic effect of Sanders type Ⅱ and type Ⅲ calcaneal fracture patients with small incision pry reduction and internal fixation with Kirschner wire and open reduction plate internal fixation.The clinical effects and the advantages of these two methods were compared.Methods 80 patients with Sanders type Ⅱ and Ⅲ calcaneal fractures who were hospitalized in our hospital from January 2016 to January2018 were selected.According to the surgical treatment they received,they were divided into the control group and the observation group,40 cases in each group.The control group was treated with open reduction plate internal fixation.The observation group was treated by small incision pry reduction and internal fixation with Kirschner wire.The preoperative preparation time,operation time,intraoperative blood loss,hospitalization time,treatment expense,fracture healing time,Maryland foot score,treatment excellent rate,and postoperative complications in two groups were analyzed retrospectively.The values of Bohler Angle,Gissane angle,middle calcaneal width were observed before and after surgery and at final follow-up.Results All patients were follow-up for 12-16 months(average 13.3 months).The preoperative preparation time,operation time,hospitalization time,intraoperative blood loss,treatment expense of the observation group were significantly lower than those of the control group(P <0.01).There was no significant difference in Maryland foot 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 b-efore and after operation and at final follow-up(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 The treatment of kirschner wire prying reduction internal fixation and open reduction internal fixation for calcaneal fractures can achieve good results.However,the former has advantages of invasive trauma,simple operation,less expense and less complication.