微创钢板辅助加压螺钉对跟骨关节内骨折患者足功能恢复及血清PGE2、SP、5-HT表达的影响

Effect of minimally invasive plate assisted compression screw on foot function recovery and expression of serum PGE_(2),SP and 5-HT in patients with intra-articular calcaneal fracture

目的探讨微创钢板辅助加压螺钉对跟骨关节内骨折患者足功能恢复及血清前列腺素E2(PGE2)、P物质(SP)、5-羟色胺(5-HT)表达的影响。方法回顾性收集本院2016年2月至2019年3月收治的87例跟骨关节内骨折患者,按治疗术式不同分为微创组(n=44)、传统组(n=43)。传统组患者行传统AO解剖钢板与螺钉治疗,微创组患者行微创钢板辅助加压螺钉治疗。对比两组患者手术情况、并发症发生情况与术前、术后1 d、3 d血清PGE2、SP、5-HT水平、炎症因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平,术后随访6~12个月,比较两组患者骨折复位情况(跟骨高度、跟骨宽度、跟骨长度、Gissane角、Bohler角、关节面台阶高度)、足关节功能恢复优良率。结果所有患者均随访6~12个月,平均(8.73±0.56)个月,随访率为100%。手术情况:微创组手术时间、住院时间、开始负重时间、骨折愈合时间短于传统组,术后VAS评分低于传统组(P<0.05);血清PGE2、SP、5-HT水平:微创组术后1 d、3 d血清PGE2、SP、5-HT水平低于传统组(P<0.05);炎症因子:微创组术后1 d、3 d血清TNF-α、CRP水平低于传统组(P<0.05);并发症:微创组并发症发生率低于传统组(P<0.05);跟骨情况:两组均无脱落病例。微创组末次随访时跟骨高度、长度、Gissane角、Bohler角高于传统组,跟骨宽度、关节面台阶高度低于传统组(P<0.05);足关节功能恢复优良率:微创组末次随访时足关节功能恢复优良率高于传统组(P<0.05)。结论微创钢板辅助加压螺钉应用于跟骨关节内骨折患者,有助于缓解疼痛,减少并发症,改善骨折复位情况,恢复足关节功能,缩短康复进程,且对血清PGE2、SP、5-HT水平影响较小。

Objective To investigate the effects of minimally invasive plate-assisted compression screws on the recovery of foot function and the expression of serum prostaglandin E2(PGE2),substance P(SP)and serotonin(5-HT)in patients with intra-articular calcaneal fractures.Methods A retrospective collection of 87 patients with intra-articular calcaneal fractures admitted to our hospital from February 2016 to March 2019,and they were divided into minimally invasive group(n=44)and traditional group(n=43)according to different treatment methods.Patients in the traditional group received traditional AO anatomical plate and screw therapy,and patients in the minimally invasive group received minimally invasive plate-as-sisted compression screw therapy.Comparing the conditions of surgery,occurrence of complications and serum PGE2,SP,5-HT levels,inflammatory factors[tumor necrosis factorα(TNFα),C-reactive protein(CRP)]of patientsbefore and 1 day and 3 days after surgeryin the two groups.After 6 to 12 months of postoperative follow-up,the fracture reduction status(calcaneal height,calcaneal width,calcaneal length,Gissane angle,Bohler angle,articular surface step height)and the excellent rate of foot joint function recovery of patients between the two groups were compared.Results All patients were followed up for 6-12 months,with an average of 8.73±0.56 months,and the follow-up rate was 100%.Surgery relatives,the operation time,hos-pitalization time,starting weight bearing time and fracture healing time of the minimally invasive group were shorter than that of the traditional group,and the postoperative VAS score was lower than that of the traditional group(P<0.05).Serum PGE2,SP,5-HT levels:the levels of serum PGE2,SP and 5-HT in the minimally in-vasive group were lower than those in the traditional group(P<0.05).Inflammatory factors:the serum TNFαand CRP levels in the minimally invasive group were lower than those in the traditional group on 1 and 3 days after operation(P<0.05).Complications,the incidence of complications in the minimally invasive group was lower than that in the traditional group(P<0.05).Calcaneus,there were no cases of shedding in the two groups.At the last follow-up of the minimally invasive group,the height,length,Gissane angle,and Bohler angle of the calcaneus were higher than those of the traditional group,and the width of the calcaneus and the height of the articular surface step were lower than those of the traditional group(P<0.05);the excellent and good rate of foot joint function recovery.The excellent and good rate of foot joint function recovery in the minimally invasive group was higher than that of the traditional group at the last follow-up(P<0.05).Conclu-sion Minimally invasive plate-assisted compression screws are used in patients with intra-articular calcane-al fractures,which can help relieve pain,reduce complications,and improve fracture reduction,restore foot joint function,shorten rehabilitation process,and have little effect on serum PGE2,SP,5-HT levels.