小切口复位经皮克氏针固定与经皮微创接骨板内固定治疗跟骨关节内骨折的临床效果比较

Comparison of clinical effects between small incision reduction and percutaneous Kirschner wire fixation and minimally invasive percutaneous plate osteosynthesis in the treatment of intra-articular calcaneal fractures

目的比较小切口复位经皮克氏针固定与经皮微创接骨板内固定治疗跟骨关节内骨折的临床效果。方法回顾性选取2019年8月至2020年9月蓝田县人民医院收治的75例跟骨关节内骨折患者作为研究对象,根据手术方式不同将其分为A组(36例)和B组(39例)。A组接受小切口复位经皮克氏针固定治疗,B组接受经皮微创接骨板内固定治疗。比较两组的手术情况、Bohler角、Gissane角、跟骨高度、跟骨宽度及踝关节功能。结果A组的手术时间、住院时间、骨性愈合时间均短于B组,手术出血量少于B组,差异具有统计学意义(P<0.05);两组的手术切口长度无显著差异(P>0.05)。术前,两组的Bohler角、Gissane角、跟骨高度及跟骨宽度无显著差异(P>0.05);术后1个月,两组的Bohler角及跟骨高度大于术前,Gissane角及跟骨宽度均小于术前,差异具有统计学意义(P<0.05);术后1个月,两组的Bohler角、Gissane角、跟骨高度及跟骨宽度无显著差异(P>0.05)。术前,两组的美国足踝外科学会(AOFAS)评分无显著差异(P>0.05);术后1个月,两组的AOFAS评分均高于术前,且A组高于B组,差异具有统计学意义(P<0.05)。结论小切口复位经皮克氏针固定与经皮微创接骨板内固定治疗跟骨关节内骨折患者的复位效果相当,但小切口复位经皮克氏针固定手术时间短、出血量少、骨性愈合快,术后踝关节功能恢复更好,值得临床推广与应用。

Objective To compare the clinical effects of small incision reduction and percutaneous Kirschner wire fixation and minimally invasive percutaneous plate osteosynthesis in the treatment of intra-articular calcaneal fractures.Methods Seventy five patients with intra-articular calcaneal fractures admitted in Lantian County People's Hospital from August 2019 to September 2020 were retrospectively selected as the research objects,and the patients were divided into group A(36 cases)and group B(39 cases)according to the different surgical methods.The group A received small incision reduction and percutaneous Kirschner wire fixation,while the group B received minimally invasive percutaneous plate osteosynthesis.The operation condition,Bohler angle,Gissane angle,calcaneal height,calcaneal width and ankle joint function were compared between the two groups.Results The operation time,hospital stay and osteonal union time of the group A were shorter than those of the group B,the amount of bleeding was less than that of the group B,and the differences were statistically significant(P<0.05);there was no significant difference in length of surgical incision between the two groups(P>0.05).There were no significant differences in Bohler angle,Gissane angle,calcaneal height and calcaneal width between the two groups before operation(P>0.05);at 1 month after operation,the Bohler angle and calcaneal height of the two groups were larger than those before operation,the Gissane angle and calcaneal width were smaller than those before operation,and the differences were statistically significant(P<0.05);at 1 month after operation,there were no significant differences in Bohler angle,Gissane angle,calcaneal height and calcaneal width between the two groups(P>0.05).Before operation,there was no significant difference in American Orthopedic Foot and Ankle Society(AOFAS)score between the two groups(P>0.05);at 1 month after operation,the AOFAS score in the two groups was higher than that before operation,that in the group A was higher than the group B,and the differences were statistically significant(P<0.05).Conclusion The small incision reduction and percutaneous Kirschner wire fixation and minimally invasive percutaneous plate osteosynthesis in the treatment of patients with intra-articular calcaneal fractures has comparable reduction effect,but the small incision reduction and percutaneous Kirschner wire fixation has shorter operation time,less amount of bleeding,faster osteonal union,and better recovery of postoperative ankle joint function,which is worthy of clinical promotion and application.