超声引导下经皮撬拨复位克氏针内固定治疗低龄儿童跟骨关节内骨折的临床效果

Clinical effect of ultrasound-guided percutaneous pry reduction and Kirschner wire internal fixation in the treatment of calcaneal intra-articular fractures in young children

目的研究超声引导下经皮撬拨复位克氏针内固定治疗低龄儿童跟骨关节内骨折的临床疗效。方法以回顾性分析为法,观察对象为2020年1月至2022年1月入海南省妇女儿童医学中心的42例跟骨关节内骨折低龄患儿,均行克氏针撬拨复位内固定治疗,参考术中引导方式分为研究组(n=21)与对照组(n=21)。研究组行超声引导下跟骨闭合复位,对照组行透视下跟骨闭合复位。比较两组患儿手术前后美国骨科协会足踝评分量表(AOFAS)评分、视觉模拟评分法(VAS)评分、跟骨交叉角(Cissane角)、跟骨结节关节角(B9hler角)、关节软骨塌陷高度与术中透视次数、术中出血量、手术时间。结果术前,两组患儿AOFAS评分、VAS评分、Gissane角、B9hler角、关节软骨塌陷高度比较,差异均无统计学意义(P>0.05);术后两组患儿AOFAS评分、B9hler角较术前升高,VAS评分、Gissane角、关节软骨塌陷高度均较术前明显下降,差异均有统计学意义(P<0.05);研究组术中透视次数为(2.71±0.78)次,较对照组[(10.34±2.62)次]低,手术时间为(28.68±6.01)min,较对照组[(60.02±9.95)min]更短,术后关节软骨塌陷高度为(1.85±0.82)mm,较对照组[(2.86±0.95)mm]低,差异均有统计学意义(P<0.05);两组术中出血量及AOFAS评分、VAS评分、Gissane角、B9hler角比较,差异均无统计学意义(P>0.05)。结论超声引导下经皮撬拨复位克氏针内固定治疗低龄儿童跟骨关节内骨折治疗临床疗效显著,手术时间较透视下跟骨闭合复位更短,辐射损伤更小,复位更好。

Objective To study the clinical efficacy of ultrasound-guided percutaneous pry reduction and Kirschner wire internal fixation in the treatment of calcaneal intra-articular fractures in young children.Methods By retrospective analysis method,the observation object was between January 2020 and January 2022 hainan province where women and children medical center in 42 cases of young children with intra-articular calcaneal fractures,the needle was in prying reduction and internal fixation treatment,the reference of guide way was divided into research group(n=21)and control group(n=21),the team line under the guidance of ultrasound with closed reduction,the control group underwent closed reduction of calcaneus under fluoroscopy.The American orthopaedic foot and ankle society questionnaire(AOFAS)score,visual analogue scale(VAS)score,Cissane angle,B9hler angle,articular cartilage collapse height,intraoperative fluoroscopy times,intraoperative blood loss,and operation time were compared between the two groups before and after operation.Results Before surgery,there were no statistically significant differences in AOFAS score,VAS score,Gissane angle,B9hler angle,and articular cartilage collapse height between the two groups(P>0.05).After operation,the AOFAS score and B9hler angle of the two groups were significantly higher than those before operation,and the VAS score,Gissane angle and articular cartilage collapse height were significantly lower than those before operation,the differences were statistically significant(P<0.05).The number of times of intraoperative fluoroscopy in the study group was(2.71±0.78)times,which was lower than that in the control group[(10.34±2.62)times],the operation time was(28.68±6.01)min,which was shorter than that in the control group[(60.02±9.95)min],the height of articular cartilage collapse after operation was(1.85±0.82)mm,which was lower than that in the control group[(2.86±0.95)mm],the differences were statistically significant(P<0.05).There was no statistically significant difference in intraoperative blood loss,AOFAS score,VAS score,Gissane angle and B9hler angle between the two groups(P>0.05).Conclusion Ultrasound-guided percutaneous pry reduction and Kirschner wire internal fixation in the treatment of calcaneal intra-articular fractures in young children has significant clinical efficacy,shorter operation time,less radiation damage and better reduction than closed calcaneal reduction under fluoroscopy.