围手术期高压氧处理联合经皮撬拨闭合复位空心钉内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折44例疗效观察

Efficacy of perioperative hyperbaric oxygen therapy on 44 cases of Sanders type Ⅱ and Ⅲ calcaneal fractures treated by percutaneous prying reduction and cannulated screw internal fixation

目的:探讨围手术期高压氧(HBO)处理对经皮撬拨闭合复位空心钉内固定(PPRCSF)治疗Sanders Ⅱ、Ⅲ型跟骨骨折(CF)患者临床疗效的影响。方法:回顾性分析2017年6月至2019年8月烟台市烟台山医院和毓璜顶医院收治的81例闭合性Sanders Ⅱ、Ⅲ型CF患者的临床资料,按照治疗方法分为观察组(n=44)和对照组(n=37)。对照组患者予以术前常规治疗,主要为抬高患肢、抗生素治疗、七叶皂苷钠和甘露醇等消肿治疗,待患者足跟皱褶试验阳性时进行PPRCSF手术。观察组患者在围手术期予以HBO治疗,其他治疗方法与对照组相同。术后第8天观察并记录2组患者切口肿胀、皮温低、表皮水疱、皮缘色暗等血运不良发生情况。统计2组患者住院时间及骨折愈合时间。术后6个月采用美国足踝外科学会评分(AOFAS)及Maryland评分评估治疗效果,并分析2组患者治疗前后Bohler和Gissane角、跟骨高度和宽度的变化。结果:观察组患者治疗后切口血运不良率(11.36%)明显低于对照组(29.73%)(P<0.05)。观察组患者入院至手术治疗时间、住院时间及骨折愈合时间均明显短于对照组(P<0.05)。术后6个月2组患者AOFAS、Maryland评分均明显高于术前(P<0.01),观察组患者治疗后AOFAS、Maryland评分明显高于对照组(P<0.05)。与治疗前比较,2组患者治疗后Bohler角明显增大,Gissane角明显缩小,跟骨高度降低,跟骨宽度增大(P<0.05)。但观察组患者治疗后Gissane角、Bohler角、跟骨宽度和跟骨高度与对照组比较差异无统计学意义(P>0.05)。结论:围手术期HBO处理联合PPRCSF治疗Sanders Ⅱ、Ⅲ型CF有利于患者术前组织肿胀消退,促进术后创面及骨折愈合,值得临床推广应用。

Objective To investigate the efficacy of hyperbaric oxygen(HBO)therapy in perioperative period on calcaneal fractures(CF)of Sanders type Ⅱ and Ⅲ treated by percutaneous prying reduction and cannulated screw fixation(PPRCSF).Methods A total of 81 patients with closed Sanders II and III CF admitted to Yantai Mountain Hospital and Yantai Yuhuangding Hospital from June 2017 to August 2019 were retrospectively analyzed.They were divided into observation group(n=44)and control group(n=37).The patients in the control group were given conventional treatment before operation,including raising the affected limb,antibiotic treatment,subsiding swelling treatment with sodium aescinate and mannitol,and then received PPRCSF operation when the heel wrinkle test was positive.The patients in the observation group were treated with HBO during the perioperative period on the basis of the treatment of the control group.On the eighth day after the operation,the incidence of poor blood supply,such as incision swelling,low skin temperature,epidermal blister,and dark skin edge,were observed and recorded.The length of hospital stay and fracture healing time of the patients in the two groups were counted.The curative effect was evaluated according to the American Orthopaedic Foot and Ankle Society(AOFAS)score and Maryland score 6 months after operation.The changes of Bohler angle,Gissane angle,and calcaneal height and width of the patients in the two groups before and after treatment were statistically analyzed.Results Eight days after operation,the incidence rate of poor blood supply at incision in the observation group(11.36%)was significantly lower than that in the control group(29.73%)(P<0.05).The period from admission to operation,the length of hospital stay,and the fracture healing time in the observation group were significantly less than those in the control group(P<0.05).All patients were followed up during the 6 months after operation.Six months after operation,AOFAS and Maryland scores of the patients in the two groups were significantly higher than those before operation(P<0.01),and the AOFAS and Maryland scores of the patients in the observation group were significantly higher than those of the control group(P<0.05).Compared with those before treatment,Bohler angle and calcaneal width of the patients in the two groups were increased after treatment;Gissane angle and calcaneal height of the patients in the two groups were decreased after treatment;all differences were statically significant(P<0.05).But there was no significant difference in Gissane angle,Bohler angle,calcaneal width,or calcaneal height between the observation group and the control group(P>0.05).Conclusion HBO therapy in perioperative period has good clinical effect on subsiding tissue swelling before operation,and on promoting postoperative wound healing and fracture healing in patients with Sanders Ⅱ and Ⅲ CF after PPRCSF,which is worthy of clinical application.