吴门医派葛氏伤科正骨手法联合经皮撬拨复位克氏针内固定与切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效比较

Comparison of curative effects of WU school of orthopaedic manipulation bone setting technique with percutaneous prying internal fixation with Kirschner wire and open reduction internal fixation

目的:比较吴门医派葛氏伤科正骨手法联合经皮撬拨复位克氏针内固定与外侧“L”形入路钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法:选取2020年1月―2021年12月于苏州市中医医院治疗的SandersⅡ、Ⅲ型跟骨骨折患者,根据随机数字表法分为治疗组和对照组。治疗组32例,采取吴门医派葛氏伤科正骨手法联合经皮撬拨复位克氏针内固定治疗;对照组32例,采取外侧“L”形入路钢板内固定治疗。比较两组患者围手术期手术时间、术中术后出血量、骨折愈合时间,手术前后的跟骨长度、宽度、高度、Bohler角、Gissane角及术后6个月的Maryland足功能评分和美国足与踝关节协会(American Orthopedic Foot Andankle Society,AOFAS)评分。结果:两组患者均获随访。两组患者的术前等待时间、骨折愈合时间、Maryland评分和AOFAS评分差异均无统计学意义(P>0.05);治疗组的手术时间、出血量明显少于对照组(P<0.05)。两组患者的跟骨长度、宽度、高度、Bohler角和Gissane角差异均无统计学意义(P>0.05);与术前相比,两组患者跟骨长度、宽度、高度、Bohler角和Gissane角术后明显恢复(P<0.05),且术后6个月与术后即刻比较丢失不明显(P>0.05)。传统切开组术后并发症的发生率高于微创组(P<0.05)结论:吴门医派葛氏伤科正骨手法联合经皮撬拨复位克氏针内固定与外侧“L”形入路钢板内固定均可有效治疗SandersⅡ、Ⅲ型跟骨骨折,且吴门医派葛氏伤科正骨手法联合经皮撬拨复位克氏针内固定治疗创伤小、操作快,具有一定优势。

Objective:To compare the clinical effect of WU school of orthopaedic manipulation bone setting technique combined with percutaneous prying reduction of Kirschner wire internal fixation and lateral“L”shaped approach plate internal fixation in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Methods:Patients with Sanders Ⅱ and Ⅲ calcaneal fractures treated in Suzhou Hospital of Traditional Chinese Medicine from January 2020 to December 2021 were selected and randomly divided into the treatment group and the control group according to random number table.In the treatment group,32 cases were treated by WU school of orthopaedic manipulation bone setting technique combined with percutaneous prying reduction of Kirschner wire internal fixation.In the control group,32 cases were treated with lateral“L”shaped approach plate internal fixation.The perioperative time,intraoperative and postoperative blood loss,fracture healing time,calcaneal length,width,height,Bohler Angle,Gissane Angle and Maryland and AOFAS scores 6 months after surgery were compared between the two groups.Results:Both groups were followed up.There were no significant differences in preoperative waiting time,fracture healing time,Maryland and AOFAS scores between the two groups(P>0.05).The operation time and blood loss in minimally invasive group were significantly less than those in traditional incision group(P<0.05).There were no statistically significant differences in calcaneal length,width,height,Bohler Angle and Gissane Angle between the two groups(P>0.05).Compared with preoperative indexes,calcaneal length,width,height,Bohler Angle and Gissane Angle of the two groups recovered significantly after surgery(P<0.05).The loss was not significant 6 months after surgery and immediately after surgery(P>0.05).The incidence of postoperative complications in the traditional incision group was higher than that in the minimally invasive group(P<0.05).Conclusion:Both WU school of orthopaedic manipulation bone setting technique combined with percutaneous prying reduction of Kirschner wire internal fixation and latera“l L”shaped approach plate internal fixation can effectively treat Sanders Ⅱ and Ⅲ calcaneal fractures,and WU school of orthopaedic manipulation bone setting technique combined with percutaneous prying reduction of Kirschner wire internal fixation have advantages of less trauma and faster operation in the treatment.