克氏针“No-touch”技术在跟骨骨折外侧L形切口中的应用

Application of Kirschner wire"No-touch"technique in lateral L-shaped incision of calcaneal fracture

目的探讨克氏针“No-touch”技术在跟骨骨折外侧L形切口中的应用效果。方法50例SandersⅡ、Ⅲ、Ⅳ型闭合性跟骨骨折手术患者,随机分为实验组和对照组,各25例。实验组利用3枚1.5 mm克氏针分别于距骨、腓骨、骰骨植入,折弯,将皮瓣向上掀开显露术野。对照组则为常规助手拉钩牵拉皮瓣显露术野。比较两组术中切口显露范围、手术时间、术后切口并发症发生情况、术后6个月随访美国足踝外科协会(AOFAS)踝与后足评分系统评分。结果实验组术中切口显露范围明显优于对照组(P<0.05);手术时间(55.68±8.90)min明显少于对照组(71.96±10.11)min(P<0.001);实验组AOFAS评分(88.28±7.37)分高于对照组的(83.76±7.10)分,比较差异有统计学意义(P<0.05);实验组术后切口并发症发生率低于对照组,但差异无统计学意义(P>0.05)。结论克氏针“No-touch”技术在跟骨骨折外侧L形切口中可明显扩大切口显露范围,缩短手术时间,不增加术后切口并发症的发生率,提高骨折复位质量,应用效果值得肯定。

Objective To investigate the application effect of Kirschner wire"No-touch"technique in lateral L-shaped incision of calcaneal fracture.Methods 50 patients with SandersⅡ,Ⅲ,andⅣclosed calcaneal fractures were randomly divided into experiment group and control group,with 25 cases in each group.In the experiment group,three 1.5 mm Kirschner wires were implanted in talus,fibula and cuboid,respectively and then bent,through which to open up the flaps for the exposure of surgical field.In the control group,the flap was pulled by conventional assistant retractor to expose the surgical field.And then,the intraoperative incision exposure range,operation time,postoperative incision complications,and scores of American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS-AHS)at 6 months after surgery were compared between the two groups.Results The scope of incision exposure in the study group was significantly better than that in the control group(P<0.05),and the operation time([55.68±8.90]min)was significantly less than that([71.96±10.11]min)of the control group(P<0.001).The AOFAS-AHS score of the study group([88.28±7.37]points)was higher than that of the control group([83.76±7.10]points),and difference was statistically significant(P<0.05).The incidence of postoperative incision complications in the study group was lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion Kirschner wire"No-touch"technique can significantly expand the operative incision exposure range,shorten operation time without increasing the incidence of postoperative incision complications,and improve the quality of fracture reduction in the lateral L-shaped incision of calcaneal fracture,so its application effect is worthy of recognition.