跗骨窦小切口手法复位内固定治疗对跟骨骨折患者炎症反应及骨代谢的影响评估

Effect of manipulative reduction and internal fixation through small incision of tarsal sinus on inflammatory response and bone metabolism in calcaneal fracture patients

目的探讨跗骨窦小切口手法复位内固定治疗对跟骨骨折患者炎症反应及骨代谢的影响。方法选取成都新华医院收治的跟骨骨折患者60例作为观察对象,按照治疗方式分为研究组32例、对照组28例。研究组采用跗骨窦小切口手法复位内固定治疗,对照组采用跟骨外侧“L”形切口入路钢板内固定治疗。比较2组跟骨结节关切角(Bohler角)、跟骨交叉角(Gissane角)、跟骨宽度、疗效、并发症、炎症因子白细胞介素(interleukin,IL)1β、IL-6、IL-22水平、骨代谢指标骨钙素(osteocalcin,OC)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、Ⅰ型前胶原氨基末端前肽(N-terminal propeptide of typeⅠprecollagen,PINP)、Ⅰ型胶原交联羧基末端肽(typeⅠcollage cross-linked-telopeptide,CTX)、抗酒石酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP)、吡啶啉(pyridinoline,PYD)水平。结果研究组术后Bohler角、Gissane角均明显大于对照组,跟骨宽度明显小于对照组(P<0.05);研究组治疗优良率为93.75%,明显高于对照组的71.43%(P<0.05);研究组炎症因子IL-1β、IL-6、IL-22水平均明显低于对照组(P<0.05);研究组OC、BALP、PINP水平均明显高于对照组(P<0.05),CTX、TRAP、PYD水平均明显低于对照组(P<0.05);研究组术后并发症总发生率为9.38%,明显低于对照组的32.14%(P<0.05)。结论跗骨窦小切口手法复位内固定治疗对跟骨骨折效果确切,可有效恢复跟骨解剖结构,改善骨代谢,且炎症应激反应小,并发症少,可推广。

Objective To investigate the effect of manipulative reduction and internal fixation with small incision for tarsal sinus on inflammation and bone metabolism in patients with calcaneal fractures.Methods Sixty patients with calcaneal fractures admitted to Chengdu Xinhua hospital were selected as observation objects,and were divided into 32 cases in the research group and 28 cases in the control group according to the treatment method.The study group was treated with manipulative reduction and internal fixation through small incision of tarsal sinus,while the control group was treated with steel plate internal fixation through l-shaped incision of lateral calcaneus.The Bohler angle,gissane angle,calcaneal width,curative effect,complications,levels of inflammatory cytokines interleukin-1β(IL-1β),IL-6,IL-22,osteocalcin(OC),bone alkaline phosphatase(BALP)and N-terminal propeptide of typeⅠprocollagen were compared between the two groups The levels of typeⅠprecollagen(PINP),typeⅠcollagen cross linked telopeptide(CTX),tartrate resistant acid phosphatase(TRAP)and pyridinoline(PYD)were measured.Results after surgery,Bohler Angle and Gissane Angle were significantly larger than those of the control group,and calcaneal width was significantly smaller than that of the control group(P<0.05).The excellent and good rate of the study group was 93.75%,which was significantly higher than that of the control group(71.43%,P<0.05).The levels of inflammatory cytokines IL-1 beta,IL-6 and IL-22 in the study group were significantly lower than those in the control group(P<0.05).The levels of OC,BALP and PINP in the study group were significantly higher than those in the control group(P<0.05),and the levels of CTX,TRAP and PYD were significantly lower than those in the control group(P<0.05).The total incidence of postoperative complications in the study group was 9.38%,which was significantly lower than that in the control group(P<0.05).Conclusion The reduction and internal fixation of small incision for tarsal sinus has a definite effect on calcaneal fractures,which can effectively restore the anatomical structure of the calcaneus and improve bone metabolism,with a small inflammatory stress response and fewer complications.Therefore,it can be popularized.