100例内踝骨折闭合复位经皮空心螺钉内固定术治疗临床观察

目的在内踝骨骨折患者中应用闭合复位经皮空心螺钉内固定术进行治疗,比较分析治疗效果以及治疗价值。方法将2015年8月—2018年8月作为实验研究的时间段,并从该时间段在该院选取100例内踝骨骨折患者作为研究对象展开分析,按照随机分配的原则将研究对象分为两组,即对照组和观察组各50例,在对照组患者中采取切开复位解剖钢板内固定术进行治疗,而在观察组中则采取闭合复位经皮空心螺钉内固定术进行治疗,比较两组患者的住院时间、完成治疗后的相关临床指标、完成治疗后的踝关节功能恢复状况、治疗效果。结果治疗优良率相较于对照组,观察组患者的治疗优良率显著较高,差异有统计学意义(P<0.05);住院时间观察组患者显著短于对照组,差异有统计学意义(P<0.05);完成治疗后的相关临床指标(术中出血量、骨痂产生所用时间以及骨折愈合所用时间)相较于对照组,差异有统计学意义(P<0.05);完成治疗后的踝关节功能恢复状况(术后3个月、术后5个月以及术后1年)与观察组相比较,对照组的评分明显较低,差异有统计学意义(P<0.05)。结论在内踝骨骨折患者中应用闭合复位经皮空心螺钉内固定术进行治疗的效果显著,在减少患者术中出血量、骨痂产生所用时间以及骨折愈合所用时间的同时也促进了完成治疗后的踝关节功能恢复状况,同时患者的住院时间也较短,值得在临床中推广应用。

闭合复位经皮空心钉内固定治疗儿童内踝Salter-HarrisⅢ型骨骺骨折的疗效观察

目的:探讨闭合复位经皮空心钉内固定治疗儿童内踝Salter-HarrisⅢ型骨骺骨折的临床疗效。方法:自2011年1月至2015年8月共收治的儿童内踝Salter-HarrisⅢ型骨骺骨折患儿28例,其中男20例,女8例,年龄9~13岁,平均年龄为11岁3个月。采用C臂X线机透视下闭合手法复位,经皮空心螺钉内固定,术后应用石膏或支具外固定3~4周,去除外固定后逐渐下地负重、行走。结果:28例患儿均获得随访,平均随访时间25个月。术后3个月所有患儿均获得骨性愈合,2年左右的随访中未发现踝关节内外翻畸形、疼痛及不稳定等症状,无骺板早闭、骺板骨桥形成及关节面不平整现象,所有患儿均能参加正常的体育活动。按Baird-Jackson踝关节功能评分标准:优24例,良4例,获得优良率100%。结论:闭合复位经皮空心钉固定治疗儿童内踝Salter-HarrisⅢ型骨骺骨折,创伤小,内固定稳定可靠,疗效满意。

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking cal- caneal plate

Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.