跟骨关节内骨折手术与非手术治疗疗效比较

A THERAPEUTIC-EFFECT COMPARISON OF THE OPERATIVE AND NON-OPERATIVE TREATMENT OF INTRA-ARTICULAR FRACTURE OF THE CALCANEUS

为比较跟骨关节内骨折手术与非手术治疗的疗效差异。选择SandersⅡ～Ⅲ 型跟骨关节内骨折 2 4例 ,随机均分为两组。非手术组行手法复位石膏固定 ,手术组采用延长的外侧途径应用钢板松质骨螺丝钉联合固定。随访时间手术组平均 30个月 ,非手术组平均 2 6个月。按Maryland足部评分 ,手术组优良率 83.3% ,非手术组优良率 4 1.7% ;非手术组治疗后并发症发生率明显高于手术组 ;Bohler’s角与Gissane角手术组治疗前后比较有显著统计学差异 ,而非手术组治疗前后无显著统计学差异。表明对于SandersⅡ 型或 Ⅲ 型的跟骨关节内骨折 ,手术治疗疗效明显优于非手术治疗。

In order to compare the therapeutic-effect difference of the operative and non-operative treatment of intra-articular fracture of the calcaneus (IAFC), 24 cases of IAFC of Shanders types II and III were randomly divided into two groups: the operative (O) and the non-operative (N) (n 12 cases each); the former was treated by manipulative reduction and plaster fixation and the latter was treated by combined plate and cancellous-bone-screw fixation through a lengthened lateral approach. The follow-up of O and N groups averaged 30 months and 26 months, respectively. According to Maryland's foot scoring, the excellent-good rates of O and N groups were 83.3% and 41.7%, respectively; the incidence of complications in N group was higher than that in O group; O group had a significant statistical difference in comparison of the pre-and post-therapeutic Bohler's and Gissane's angles but N group did not, suggesting that the operative treatment of IAFC of Shanders types II and III has an obvious advantage over the non-operative one.