跟骨骨折闭合撬拨辅以中医整复手法复位空心钉内固定术的临床疗效

Clinical effects of closed prying reduction assisted by traditional Chinese medicine manipulative reduction and internal fixation with hollow nails in calcaneal fractures

目的:探讨跟骨骨折闭合撬拨复位空心钉内固定术的临床疗效。方法:选取2017年1月~2019年12月芜湖市中医医院收治的SandersⅡ、Ⅲ型跟骨骨折患者60例60足为研究对象,均采用闭合撬拨辅以中医整复手法复位空心钉内固定术治疗。分析患者手术情况、手术前后距下后关节面移位、治疗效果、并发症发生率、治疗费用等。术前和术后2周均取空腹静脉血检测比较C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)和D二聚体(D-D)等炎症指标水平。结果:患者术后2周的各炎症指标水平均较术前降低(P<0.05)。患者术后距下后关节面移位低于术前(P<0.05)。患者治疗效果为优和良的比率分别为70.00%和26.67%,出血量、手术时间、术后住院时间、骨折愈合时间、术后2周VAS评分、治疗费用、并发症发生率分别为(45.65±8.45)mL、(50.22±8.79)min、(5.11±1.16)d、(71.44±5.88)d、(2.15±0.44)分、(5721.11±355.26)元和3.33%。结论:跟骨骨折闭合撬拨复位空心钉内固定术可行性和安全性均良好,值得临床推广应用。

Objective:To investigate the clinical effect of closed pry reduction and internal fixation with hollow nail for calcaneus fracture.Methods:Sixty patients(60 feet)with SandersⅡandⅢcalcaneal fractures admitted to and treated in our hospital were included from January 2017 to December2019.All patients underwent closed prying reduction assisted by traditional Chinese medicine manipulative reduction and internal fixation with hollow nails.The clinical data were analyzed on the operation indexes,posterior subtalar articular surface displacement before and after operation,treatment effect,complication rate and medical cost.Fasting venous blood was taken before and 2 weeks after operation to detect and compare the levels of plasma C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)and D-Dimer(D-D).Results:The level of plasma inflammation index was lower in in two weeks after operation than that before operation in all patients(P<0.05),and posterior subtalar articular surface displacement was better managed following surgery(P<0.05).By treatment effect,the ratio of excellence and better was 70.00%and 26.67%,respectively.The bleeding volume,operative time,postoperative hospital stays,fracture healing time,VAS scores in 2 weeks after treatment,treatment cost and complication rate were(45.65±8.45)mL,(50.22±8.79)min,(5.11±1.16)d,(71.44±5.88)d,(2.15±0.44)min,(5721.11±355.26)RMB yuan and 3.33%,respectively.Conclusion:Closed prying reduction and internal fixation with hollow nail can be feasible and safe to treatment of calcaneus fracture,and is worthy of wider clinical recommendation.