Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Evaluation of Percutaneous Pedicle Screw Fixation in Patients with Pyogenic Spondylitis of the Thoracolumbar Spine

Background: Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. Objective: To evaluate the impact of PPS fixation in patients with PS. Study Design: A retrospective analysis of the medical records. Subjects, Methods: We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases showing effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases showing initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from the first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. Results: These cases were divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p = 0.051) and CRP inversion (p = 0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p = 0.020, p = 0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p = 0.354) between the two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. Conclusion: PPS fixation was effective to achieve shortening the period to ambulation and discharge or transfer. But it was not effective in infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS showing resistance to initial treatment.

The application of C1-C2 pedicle screw internal fixation on the upper cervical diseases of children

Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point

Clinical application of improved 2D computer-assisted fluoroscopic navigation through simulating a 3D vertebrae image to guide pedicle screw internal fixation

Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction

Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients:a Comparison of All Pedicle Screws versus Hybrid Instrumentation

Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.

三维组架螺钉与环形钢板治疗Sanders ⅢAB型跟骨骨折的有限元分析

目的 探讨三维组架螺钉与环形钢板对SandersⅢAB型跟骨骨折的生物力学稳定性的影响。方法 收集1名26岁志愿者跟骨CT和MRI数据,建立SandersⅢAB型跟骨骨折的三维有限元模型,分别使用三维组架螺钉与环形钢板固定,施加700 N纵向载荷,比较不同模型骨块及内固定应力与位移变化情况。结果 在700 N纵向载荷下,两组模型骨块最大位移以及骨块与内固定最大应力均集中于后距关节面内固定与骨折线相交处。三维组架螺钉模型与环形钢板模型骨块整体位移相近。相较于环形钢板模型,三维组架螺钉模型骨块及内固定的最大应力和平均应力更小,位移与应力变化情况更接近完整跟骨模型。结论 SandersⅢAB型跟骨骨折固定时,三维组架螺钉与环形钢板两种固定方式均能提供良好稳定性。三维组架螺钉的生物力学性能优于环形钢板,更符合生物力学特点。

三维组架螺钉与微创钢板固定SandersⅢ型跟骨骨折的有限元分析

背景:经皮复位加压固定的三维组架螺钉内固定在治疗SandersⅢ型跟骨骨折上已经取得了满意的临床疗效,但在生物力学方面是否可以达到微创钢板内固定的稳定性,以及对比之后的优势与缺点还不得而知。目的:通过有限元分析方法探讨不同内固定装置对SandersⅢ型跟骨骨折的固定效果。方法:选择1名26岁成年健康男性志愿者,根据其跟骨CT数据制作SandersⅢ型跟骨骨折有限元模型。选用经皮微创三维组架螺钉、跗骨窦微创钢板分别固定跟骨骨折模型,分别施加350,700N纵向载荷,分析2种模型的位移、应力分布情况,比较各种模型的稳定性。结果与结论:①三维组架螺钉模型中骨块与内植物的峰值应力明显低于微创钢板模型,三维组架螺钉模型中骨块与内植物的平均应力也明显低于微创钢板模型;②2种模型的最大位移均位于后距关节面内侧,三维组架螺钉模型的最大位移小于微创钢板模型;③微创钢板模型前突骨块与内侧骨块的纵向位移更小,三维组架螺钉模型内侧骨块与中段骨块的横向与垂直位移更小;④提示2种内固定模型均能提供满意的固定效果,其中三维组架螺钉模型使应力分布更均匀、骨块综合位移更小,能提供更好的横向与垂直稳定性,而微创钢板在维持纵向稳定性上更具优势。

Effect of Locking Compression Plate on the Treatment of Limb Fracture and the Effect of Operative Success Rate and Postoperative Recovery Time

Objective:To analyze the effect of locking compression plate on the success rate of operation and the time of postoperative recovery.Methods:120 patients with limb fractures from March 2018 to March 2020 were randomly divided into control group(60 cases)and observation group(60 cases).The control group was treated with plate screw internal fixation,The observation group used locking compression plate internal fixation,Compare the effect of treatment,the success rate of operation and the time of postoperative recovery.results:compared the effective rate of the two groups,the observation group(93.33%)was significantly higher than the control group(75.00%).Compared with the two groups,the success rate of operation and the time of postoperative recovery,the observed composition power was higher than that of the control group,and the postoperative recovery time was lower than that of the control group,P<0.05.Conclusion:The use of locking compression plate for the treatment of limb fracture can significantly increase the probability of successful operation,shorten the recovery time after operation,the overall curative effect is ideal,and the clinical popularization value is high.

斜外侧腰椎椎间融合联合经皮椎弓根钉内固定后前凸角与融合器沉降的关系

背景:随着医疗技术的不断进步,斜外侧腰椎椎间融合联合经皮椎弓根钉内固定已成为治疗腰椎退行性疾病的一种常用方法,然而关于术后不同节段前凸角变化与融合器沉降之间的关系尚缺乏深入研究。目的:探究斜外侧腰椎椎间融合联合经皮椎弓根钉固定后不同节段前凸角变化与融合器沉降的关系。方法:选择2019年2月至2023年4月于潍坊市中医院行斜外侧腰椎椎间融合联合经皮椎弓根钉固定治疗的腰椎退行性疾病患者93例为研究对象,根据术后椎间隙高度丢失值,分为融合器沉降组(25例,≥2 mm)和非融合器沉降组(68例,<2 mm)。采用多因素Logistic回归法分析融合器沉降的危险因素,应用逐步回归法评估各危险因素与融合器沉降的关系,构建风险预测模型并评价。结果与结论:①最终校正混杂因素后,腰椎前凸角丢失值和节段前凸角改善值均与融合器沉降风险仍存在独立相关性(P<0.05);②年龄、Oswestry功能障碍指数、椎间隙高度改善值、节段前凸角改善值以及腰椎前凸角丢失值,均是融合器沉降发生的独立影响因素(P<0.05),其中年龄、腰椎前凸角丢失值、椎间隙高度改善值和节段前凸角改善值与融合器沉降关联最紧密;③多元Logistic回归模型分析结果显示,当P=0.80时,约登指数最高,预测效果最好,准确度为89.27%,灵敏度为86.67%,特异度为89.89%;模型评价结果显示,其区分度较好、准确度较高;④随着腰椎前凸角丢失值和节段前凸角改善值升高,融合器沉降风险增加,影响临床疗效;⑤提示年龄、腰椎前凸角丢失值、椎间隙高度改善值和节段前凸角改善值与融合器沉降关联最紧密,临床医生应多加关注。

纤维带与无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤

背景:Lisfranc韧带是维持足部横弓与纵弓的重要结构,Lisfranc损伤为一种严重的中足损伤。Lisfranc韧带损伤是复杂的,其治疗以及首选的固定方法有争议。目的:比较钢板联合Suturetape与钢板联合无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤的短期疗效。方法:回顾性分析东莞市中医院骨七科2019年1月至2022年6月因第1,2跖骨近端粉碎性骨折Lisfranc损伤患者48例,其中25例采用钢板联合Suture tape固定(观察组),23例采用钢板联合无头加压螺钉固定(对照组)。术前参照影像学资料,根据Myerson分类系统进行分型;术后随访根据骨折愈合时间、目测类比评分、美国足踝外科学会标准评估足功能恢复情况,并对两组术后并发症进行比较分析。结果与结论:①两组患者均顺利完成手术并获得随访,随访时间12-36个月,平均(18.0±5.42)个月;②两组患者手术时间、术中出血量比较差异均无显著性意义(P>0.05);③观察组较对照组骨折愈合时间稍长,差异有显著性意义(P<0.05);④术后3,6,12个月随访,观察组较对照组目测类比评分明显降低(P<0.05);⑤术后6,12个月,观察组术后各时间点随访足功能AOFAS评分较螺钉组明显改善(P<0.05),且均较术前显著提高(P<0.05);⑥术后观察组出现1例创伤性关节炎,对照组出现1例切口感染、1例螺钉断裂及2例创伤性关节炎,两组比较差异无显著性意义(P>0.05),考虑与样本量偏少有关;⑦提示对于第1,2跖骨近端粉碎性骨折Lisfranc损伤,实施钢板联合Suture tape内固定治疗Lisfranc关节损伤效果可靠,可改善患者足关节功能,且具有手术创伤小、术后并发症少、远期医源性创伤性关节炎风险低的优势,较无头加压钉更有利于足功能的恢复。

跗骨窦入路空心钉内固定和外侧扩大型切口钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折比较

目的比较跗骨窦入路空心钉内固定和外侧扩大型切口钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折的治疗效果。方法笔者选取2013年2月-2015年2月期间接诊的80例跟骨骨折患者作为研究对象,将其进行随机分组,每组各40例。两组均进行常规检查,对照组采用外侧扩大型切口钢板内固定术进行治疗,研究组采用跗骨窦入路空心钉内固定术进行治疗。检测与记录两组患者的平均手术时间、术中出血量、切口愈合时间、平均住院时间等基本手术情况,跟骨关节内骨折在手术前后的长度、宽度、高度、Bhler角、Gissane角等各指标值,手术后Maryland评分、美国足踝协会脚踝与后足功能评分（AOFAS）与SH-36评分、手术后足部功能的恢复情况以及术后并发症发生的情况等,并对其结果进行比较分析。结果研究组患者在平均手术时间、术中出血量、切口愈合时间、平均住院时间等分别为（50.3±4.5）min、（15.8±2.3）m L、（4.3±1.3）d、（4.9±0.8）d,均明显低于对照组,差异具有统计学意义（P〈0.05）。术后,两组患者的各指标值均有改善,与术前比较,差异有统计学意义（P〈0.05）;研究组患者的变化程度大于对照组,具有统计学意义（P〈0.05）。两组患者的Maryland评分在功能、疼痛方面,差异无统计学意义（P〉0.05）,而研究组患者的AOFOS评分、SH-36评分分别为（91.8±1.4）分、（79.3±2.4）分,明显高于对照组,差异具有统计学意义（P〈0.05）。研究组患者的总优良率为75.0%,明显高于对照组（50.0%）,差异具有统计学意义（P〈0.05）。术后,研究组患者的并发症总发生率（10%）明显低于对照组（30%）,差异具有统计学意义（P〈0.05）。结论采用跗骨窦入路空心钉内固定术治疗跟骨骨折可以明显缩短手术时间、切口愈合时间以及住院时间,降低术中出血量,有利于降低术后并发症的发生率,提高术后后足部功能的恢复速度,较外侧扩大型切口钢板内固定术具有更好的疗效,具有临床应用价值,值得推广。

O臂导航在椎弓根发育性狭窄胸腰椎骨折中的精准应用

背景:传统透视辅助治疗椎弓根发育性狭窄的胸腰椎骨折时精准置钉存在困难,O臂导航辅助系统在普通的椎弓根置钉中精准性更高,但关于O臂导航辅助置钉在椎弓根发育狭窄胸腰椎骨折中的应用国内外鲜有报道。目的:探讨O臂导航辅助经皮椎弓根置钉在椎弓根发育性狭窄的胸腰椎骨折患者中的准确性。方法:回顾性分析2021年1月至2023年3月中部战区总医院骨科行经皮椎弓根螺钉内固定的53例椎弓根发育性狭窄的胸腰椎骨折患者,其中出现发育性狭窄的椎弓根共208个(患者多处椎弓根发育狭窄的分开统计)。依据手术方式分为2组:O臂导航组98个椎弓根,C臂透视组110个椎弓根。比较两组患者解剖学穿孔评分、功能性穿孔评分、实际与预期钉道的水平面、矢状面角度差等术后影像资料。结果与结论:①两组患者在椎弓根最窄宽度(pow)上没有显著差异(P>0.05);两组患者在不同程度的狭窄分组中(轻度狭窄组:6 mm≤pow<7 mm,中度狭窄组:5 mm≤pow<6 mm,重度狭窄组:pow<5 mm)的比例也没有显著差异(P>0.05);②O臂组在解剖学穿孔和功能性穿孔上的整体等级及评分低于C臂组,差异有显著性意义(P<0.001);在实际钉道与预期钉道夹角差方面,O臂组实际与预期钉道的角度偏差更小,差异有显著性意义(P<0.05);③在轻度及中度狭窄组中,O臂组在解剖学穿孔、功能性穿孔以及实际钉道与预期钉道夹角差方面表现出明显的优势,差异有显著性意义(P<0.001);④O臂组在解剖学穿孔和功能性穿孔方面整体表现更佳,尤其在T12-L2节段,其优势更加显著;此外,O臂组在各节段的实际钉道与预期钉道夹角差方面均优于C臂组;⑤因此采用O臂导航辅助经皮置钉治疗椎弓根发育性狭窄的胸腰椎骨折,经皮置钉精准度及安全性更高。

前路Z-Plate钢板治疗脊柱椎体爆裂型骨折的临床疗效观察

目的观察Z-Plate钢板治疗脊柱椎体爆裂型骨折的临床疗效。方法通过对比后路椎弓根内固定治疗,观察分析前路Z-Plate钢板治疗的临床疗效,并用统计学方法对两种方法的治疗效果进行差异性检验。结果后路椎弓根内固定治疗和前路Z-Plate钢板治疗的临床疗效差异具有统计学意义。结论前路Z-Plate钢板治疗效果明显优于后路椎弓根内固定治疗。

有限切开+经皮螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折

2007年7月～2011年7月,我们应用有限切开+经皮螺钉内固定治疗25例SandersⅡ、Ⅲ型跟骨骨折患者,取得了满意的效果。1材料与方法1.1病例资料本组25例(28足),男20例(23足),女5例(5足),年龄18～65岁。左12足,右16足,均为跟骨闭合性损伤。

经皮撬拔闭合复位空心钉内固定术治疗跟骨sandersⅡ、Ⅲ型骨折

目的探讨经皮撬拔闭合复位空心钉内固定术治疗跟骨sandersⅡ、sandersⅢ型骨折,为临床应用提供指导。方法回顾性选择90例sandersⅡ、Ⅲ型跟骨骨折患者,根据手术方式分为对照组与观察组,各45例。对照组行切开复位钢板内固定术,观察组行经皮撬拨闭合复位空心钉内固定术。记录并比较两组手术情况、VAS评分、足踝功能及并发症等情况。结果与对照组比较,观察组患者手术时间、住院时间缩短,术中出血量、术后24 h引流管引流量减少(P<0.05);两组患者术后5天Bohler角、Gussane角、跟骨宽度、跟骨高度均较术前明显改善(P<0.05),而术后两组间差异无显著性(P>0.05);两组术后VAS评分均较术前降低(P<0.05),观察组术后1年VAS评分低于对照组(P<0.05);与对照组比较,观察组Maryland足踝功能评分优良率显著升高(P<0.05);随访期间观察组并发症显著低于对照组(P<0.05)。结论经皮撬拨闭合复位空心钉内固定术能达到切开复位钢板内固定术相似的效果,且在改善远期疼痛、足踝功能方面效果更显著,安全可靠,可在基层医院推广应用。

组合式全螺纹空心钉与传统钢板内固定治疗SandersⅡ型和Ⅲ型跟骨骨折的疗效

目的探讨组合式全螺纹空心钉内固定与传统钢板内固定治疗SandersⅡ型和Ⅲ型跟骨骨折的临床疗效。方法回顾性分析上海公利医院2016年1月至2022年12月收治的80例跟骨骨折患者资料。其中39例采用组合式全螺纹空心钉内固定治疗,41例采用传统钢板内固定治疗。比较两组患者围术期情况、影像学及长期随访资料。结果两组患者术前一般资料比较均无统计学差异(P>0.05),具有可比性。空心钉组和钢板组术前准备时间分别为(3.7±2.1)d和(4.6±2.2)d,住院时间分别为(8.8±3.7)d和(15.9±7.3)d,手术时间分别为(129.9±34.5)min和(140.7±34.4)min,术中出血量分别为(37.4±25.9)mL和(65.5±53.6)mL,以上项目两组间差异均有统计学意义(P<0.05)。术后伤口并发症空心钉组4例(10.2%)、钢板组9例(21.9%),两组间无统计学差异(P>0.05)。两组患者Gissane角、Bohler角术后即刻均较术前改善(P<0.05),而两组间比较术前、术后均无统计学差异(P>0.05)。所有患者术后平均获(14.9±3.65)个月(12~26个月)随访,术后12个月空心钉组美国骨科协会足踝外科分会(AOFAS)评分为(89.0±7.8)分,优22例,良14例,可3例,优良率为92.3%;钢板组AOFAS评分为(87.8±9.6)分,优18例,良19例,可4例,优良率为90.2%,两组AOFAS评分无统计学差异(P>0.05)。结论与传统钢板内固定相比,组合式全螺纹空心钉内固定在达到相同优良率的基础上,具有创伤小、术前准备时间及住院时间短等优势。

小切口切开复位全螺纹空心螺钉与微创解剖锁定接骨板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的短期疗效比较

背景:跟骨骨折可能累及各关节面,治疗不当会造成畸形愈合,导致创伤性关节炎,具有较高致残率,严重影响患者的日常生活,常需要手术治疗。目的:比较小切口切开复位全螺纹空心螺钉与微创解剖锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法:选取2016年6月至2018年3月收治的SandersⅡ、Ⅲ型跟骨骨折患者82例,随机分为接骨板组和螺钉组,每组各41例。接骨板组采用微创解剖锁定接骨板固定,螺钉组采用全螺纹空心钉固定。比较两组患者手术时间、住院费用、骨折愈合时间、手术前后B?hler角和Gissane角,并采用Maryland评分系统对患者术后6个月的足部功能恢复情况进行评估。结果:所有患者均获得随访,随访时间8~15个月,平均(11.3±3.6)个月。两组患者手术时间比较有统计学差异(P<0.05),螺钉组明显短于接骨板组;住院费用和骨折愈合时间的差异无统计学意义(P>0.05)。两组患者术后B?hler角和Gissane角均较术前明显改善,差异有统计学意义(P<0.05),但两组间患者术后跟骨B?hler角和Gissane角比较,差异均无统计学意义(P>0.05)。螺钉组和接骨板组患者术后半年功能恢复优良率分别为80.5%、82.9%,差异无统计学意义(P>0.05)。结论:小切口切开复位全螺纹空心螺钉与微创解剖锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折均是治疗跟骨骨折的有效术式,短期疗效肯定,但全螺纹空心螺钉固定能明显缩短手术时间,减轻手术创伤,更有利于患者术后康复。

不同手术入路内固定方式在Sanders Ⅲ型跟骨骨折患者中的应用观察

目的探讨经皮撬剥复位固定、跗骨窦入路螺钉固定、扩大外侧入路钢板固定在SandersⅢ型跟骨骨折患者中的应用效果。方法选取2017年8月—2018年12月本院收治的SandersⅢ型跟骨骨折患者135例,根据治疗方法的不同分为A、B、C组各45例,A组行经皮撬剥复位固定,B组行跗骨窦入路螺钉固定,C组行扩大外侧入路钢板固定。比较3组住院时间、术中出血量、手术时间及切口愈合时间,术前及术后7 d美国足踝外科学会(AOFAS)评分及骨折愈合情况,术前及术后7 d跟骨结节关节角(Bohler角)、跟骨交叉角(Gissane角)、跟骨宽度、根骨高度和术后7 d并发症发生情况。结果A、B组手术时间、切口愈合时间及住院时间较C组短,术中出血量少于C组,差异均有统计学意义(P<0.01)。术后7 d 3组Bohler角及Cissane角均大于术前,跟骨高度及跟骨宽度均低于术前,差异有统计学意义(P<0.05或P<0.01)。术后7 d 3组AOFAS评分均高于术前(P<0.01),3组术后骨折愈合优良率比较差异无统计学意义(P>0.05)。A、B组术后7 d总并发症发生率均低于C组(P<0.05)。结论经皮撬剥复位固定、跗骨窦入路螺钉固定、扩大外侧入路钢板固定治疗SandersⅢ型跟骨骨折效果相当,但经皮撬剥复位固定及跗骨窦入路螺钉固定较扩大外侧入路钢板固定能缩短手术时间、切口愈合时间及住院时间,减少术中出血量及降低术后并发症发生率。

微创空心螺钉与解剖钢板内固定治疗SanderⅡ、Ⅲ型跟骨骨折的效果

目的:研究微创空心螺钉与解剖钢板内固定治疗SanderⅡ、Ⅲ型跟骨骨折的临床效果。方法:选取2016年6月-2021年5月广东省水电医院收治的80例跟骨骨折患者作为研究对象。按随机数字表法将其分为微创组和解剖组,各40例。解剖组给予切开复位解剖钢板内固定治疗,微创组给予微创空心螺钉治疗。比较两组围手术期指标、解剖学指标、疼痛情况和足部功能及并发症。结果:微创组手术时间、住院时间短于解剖组,出血量少于解剖组,完全负重时间早于解剖组(P<0.05)。术后3个月,两组B;hler角、Gissane角及跟骨宽度比较差异均无统计学意义(P>0.05)。术后3个月,微创组视觉模拟评分法(VAS)评分低于解剖组(P<0.05),美国足踝外科协会(AOFAS)评分高于解剖组(P<0.05)。微创组并发症发生率仅为7.5%,明显低于解剖组的25.0%(P<0.05)。结论:微创空心螺钉和解剖钢板内固定治疗SanderⅡ、Ⅲ型跟骨骨折均有较好效果,但微创空心螺钉治疗操作更便捷,手术时间更短,出血量更少,明显缩短患者住院时间和负重时间,缓解疼痛,术后并发症更少,值得临床应用及推广。

A NEW DESIGN OF THE S.S.P.F. SCREW

The new design screw of the S.S.P.F. is better than the old.