关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折

Arthroscopy-assisted balloon dilatation plasty for intra-articular calcaneal fractures with moderate and severe malnutrition

目的分析关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折的临床疗效。方法回顾性分析2014年3月至2017年2月中国人民解放军联勤保障部队第910医院骨科收治的跟骨关节内骨折患者55例。其中,男14例,女41例;年龄47~76岁,平均(61.2±8.7)岁;骨折Sanders分型:Ⅱ型12例,Ⅲ型17例,Ⅳ型26例。营养不良程度:中度40例,重度15例;跟骨骨密度T值-5.2^-2.7,平均-(4.1±0.6)。根据手术方式分为"关节镜+球囊"组15例、单纯球囊组12例、螺钉组8例和钢板组20例。记录手术时间、术中术后出血量、住院时间、术后B?hler角和Gissane角、各时间点关节面塌陷高度及各时间点VAS评分和AOFAS评分。结果 "关节镜+球囊"组手术时间长于单纯球囊组和螺钉组(P<0.01),但低于钢板组(P<0.01);而术中、术后出血量和住院时间方面,与单纯球囊组、螺钉组差异无统计学意义(P>0.05),但低于钢板组(P<0.01)。"关节镜+球囊"组和单纯球囊组各时间点的VAS评分和AOFAS评分比较,差异无统计学意义(P>0.05);但"关节镜+球囊组"、单纯球囊组与螺钉组、钢板组比较,差异有统计学意义(P<0.01)。四组间术后B hler角和Gissane角比较,差异无统计学意义(P>0.05)。在术后6、12、24个月时"关节镜+球囊"组和单纯球囊组比较关节面塌陷高度比较,差异无统计学意义(P>0.05);螺钉组和钢板组关节面塌陷高度比较,差异也无统计学意义(P>0.05);但"关节镜+球囊"组与螺钉组、钢板组,单纯球囊组与螺钉组、钢板组关节面塌陷高度比较,差异有统计学意义(P<0.01)。结论关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折,具有操作简单、安全、康复期短的优点,值得临床推广。

Objective To evaluate the effect of arthroscopy-assisted balloon dilatation plasty for intra-articular calcaneal fractures with moderate and severe malnutrition.Methods Between March 2014 and February 2017,55 patients with intra-articular calcaneal fractures were treated at Department of Orthopedics,the 910 th Hospital of Chinese PLA.There were 14 males and 42 females.The average age was(61.2±8.7)years.According to Sanders classification,there were 12 cases in typeⅡ,17 cases in typeⅢand 26 cases in typeⅣ.There were 40 cases with moderate malnutrition and 15 cases with severe malnutrition.The average bone density T value was–(4.1±0.6).According to surgery type,all patients were divided into 4 groups:15 cases in arthroscopy group,12 cases in balloon group,8 cases in screw group and 20 cases in plate group.Operation time,blood loss,in-patient time,preoperative Bohler angle and Gissane angle,sinking height of articular,VAS and AOFAS were recorded.Results Operation time in arthroscopy group was more than balloon group and screw group(P<0.01),but was less than plate group(P<0.01).Regard to blood loss and in-patient time,there was no significant difference among arthroscopy group,balloon group and screw group(P>0.05),but there was significant difference between arthroscopy group and plate group(P<0.01).Regard to VAS and AOFAS,there was no significant difference between arthroscopy group and balloon group(P>0.05),and there was significant difference between arthroscopy group and screw group,arthroscopy group and plate group(P<0.01).The difference among 4 groups was not significant(P>0.05).At 6 th month,12 th month,24 th month,there was no significant difference between arthroscopy group and balloon group(P>0.05),screw group and plate group(P>0.05),but there was significant difference between arthroscopy group and screw group(P<0.01),arthroscopy group and plate group(P<0.01),balloon group and screw group(P<0.01),balloon group and plate group(P<0.01).Conclusion Arthroscopy-assisted balloon dilatation plasty for intra-articular calcaneal fractures with moderate and severe malnutrition,have advantages of easy manipulation,safety and short convalescence,and is worth spreading.