External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months （range 12-30 months）. The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation （P〈0. 01）, the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

Objective: To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods: Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases (16 sides) with intra-articular calcaneal fractures including 13 males (14 feet) and 2 females (2 feet) ,with average age of 36. 6 years (24–61 years). All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ (3 type Ⅱ a, 3 type Ⅱ b and 8 type Ⅱc) and 2 feet of type IIIac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results: All patients were followed up for an average of 18.4 months (ranged, 12 to 34 months). No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group (86.5±4.4) was better than in joint depression type group (81.2±1.7, P<0.05). Radiography showed basic restoration of B?hler’s angle, Gissane’s angle and calcaneal shape. Conclusion: The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders II and III type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.

Total knee arthroplasty and fractures of the tibial plateau

Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

Application of medial column classification in treatment of intraarticular calcaneal fractures

BACKGROUND There are many types of treatments for calcaneal fractures,including conservative treatment,conventional surgical treatment,and minimally invasive surgery.The choice of specific treatment options is still controversial.Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic.A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus;however,many studies have reported a high incidence of postoperative incision complications.Although there are many methods for the classification of intra-articular calcaneal fractures,it is generally believed that the computed tomography(CT)classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures.However,this method has no clear guiding significance for the choice of surgical incision and surgical plan.AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.METHODS From July 2017 to July 2018,91 patients,including 60 males and 31 females aged 27 to 60 years,were enrolled.All participants had closed intra-articular calcaneal fracture,and their surgical options were selected under the guidance of medial column classification.The patients'fractures were classified according to the Sanders classification:Type II,35 cases;Type III,33 cases;and Type IV,23 cases.Among them,53 patients had medial column displacement(shortened varus)and underwent open reduction and internal fixation with L-lateral incision of the calcaneus;38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision.The calcaneus Bohler angle,Gissane angle,length,width,height,and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up.Foot function recovery was assessed by the Maryland foot scoring criteria.RESULTS All patients were followed for 5 to 14 mo,with an average of 10.5±2.9 mo.The fractures of all patients healed,and the healing time was 10 to 19 wk,with an average of 10.8±1.5 wk.One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection.The patient's fracture healed 5 mo after surgery.One patient developed a sural nerve injury,and the symptoms disappeared 3 mo after surgery.The patients were assessed according to the Maryland foot scoring system:Excellent in 77 cases,good in 10,and fair in 4.The excellent and good rate was 95.6%.CONCLUSION Medial column classification can effectively guide the surgical selection for intraarticular fractures of the calcaneus.

Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long-Term Follow-Up

There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcaneal fractures who were treated surgically. In these patients open reduction and internal fixation were performed using a calcaneal reconstruction plate. The functional outcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the satisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.

Operative vs nonoperative treatment of displaced intraarticular calcaneal fracture: A meta-analysis of randomized controlled trials

AIM: To investigate clinical efficacy of displaced intraarticular calcaneal fracture(DIACF) following operation and nonoperation. METHODS: Literature search was performed of Pub Med and Cochrane Library by two independent authors to identify randomized controlled trials(RCTs) comparing operative vs nonoperative treatment of DIACF from inception to December 31 st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or randomeffects models were adopted with P > 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS: Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job(P = 0.006). No statistical differences were found between the two groups in residual pain(P = 0.33), shoe fitting problems(P = 0.07), limited walking distance(P = 0.56) or secondary late arthrodesis(P = 0.38). However, operative treatment was associated with a higher complication rate(P = 0.003). Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems(P < 0.0001) in operative group, the two groups had similar complication rate in deep wound infection(P = 0.34),compartment syndrome(P = 0.46), thromboembolism(P = 0.32), reflex sympathetic dystrophy(P = 0.51) or traumatic arthritis secondary to DIACF(P = 0.43).CONCLUSION: Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.

Stress fractures in uncommon location:Six case reports and review of the literature

BACKGROUND Individuals’interest in sports activities has been increasing,contributing to more stress fracture occurrences in uncommon locations on the skeleton.In this study,several cases of stress fractures in atypical locations are presented,and the possibility of combining diagnostic methods to make accurate and quick diagnoses is explored.Additionally,different causes of stress fractures,as well as various modalities of treatment,are highlighted.Other potential factors of stress fractures were identified by a literature review.CASE SUMMARY Six cases of stress fractures in the calcaneus,intermediate cuneiform bone,sacrum,tibia(bilateral),navicular bone and femoral neck are presented,with different types of diagnostic imaging and treatments.All of the cases were associated with an aspect of mobility because all of the patients were physically active in various sport disciplines.CONCLUSION The type of therapeutic procedure selected should depend on the specific clinical case,i.e.,the patient’s condition and level of physical activity.

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76&deg;and 64&deg;, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

Stress analysis of three-dimensional finite element model of malunion calcaneus during gait

Objective: To analyze the stress distribution of calcaneus with posterior articular facet compressed after fracture and talus during gait. Methods: A wedge under the posterior articular was transected from a normal finite element model of calcaneus and talus to simulate malformation of compression of the posterior facet after fracture of calcaneus. The model was used to simulate for three subphases of the stance during the gait(heel strike, midstance, push off) and calculate the finite element. The results were compared with normal situation. Results: The stress distribution within the bone in situation of malformation was obtained and regions of elevated stresses for three subphases were located. The results were significantly different from that of normal situation. Conclusion: The simulation of calcaneus and talus in malformation has important clinic implication and can provide an insight into the factors contributing to many clinic pathogenic changes after fracture of calcaneus.

超前镇痛方案对跟骨关节内骨折患者OPG/RANKL信号通路因子表达的影响

目的 探讨跟骨关节内骨折患者采用超前镇痛方案对骨保护素(OPG)/核因子-κB受体活化因子配体(RANKL)信号通路因子表达的影响。方法 回顾性选取2017年2月至2022年2月大庆油田总医院收治的跟骨关节内骨折患者100例,依据镇痛方案不同分为对照组和观察组,每组各50例。对照组患者接受常规性静脉自控镇痛方案,观察组患者接受地佐辛超前镇痛联合常规性静脉自控镇痛方案。统计分析两组围手术期指标(术中出血量、手术时间、术后引流量、术后引流时间、住院时间),麻醉前、手术前、手术后即刻的血流动力学(平均动脉压、心率),手术前、手术后1 d的应激反应[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)],手术后即刻,手术后6 h、12 h、1 d的镇静[Ramsay镇静评分(RSS)、视觉模拟评分法(VAS)评分]和镇痛效果,以及手术后1 d、手术后1周的血清OPG、RANKL含量和术后并发症发生情况。结果 两组患者的术中出血量、手术时间比较,差异均无统计学意义(P>0.05);观察组患者的术后引流量为(59.86±2.54) mL,少于对照组[(110.97±9.41) mL],术后引流时间、住院时间分别为(123.23±9.82) h、(5.61±0.45) d,均短于对照组[(178.22±9.32) h、(8.01±0.31) d],差异均有统计学意义(P<0.05)。麻醉前、手术前、手术后即刻,两组患者的平均动脉压、心率比较差异均无统计学意义(P>0.05)。手术后1 d,两组患者的血清CRP、TNF-α、IL-6、PGE2水平均明显高于手术前,观察组患者的血清CRP、TNF-α、IL-6、PGE2水平分别为(5.11±1.47) mg/L、(43.15±7.51)μg/L、(32.52±5.31) ng/L、(138.11±12.68) pg/mL,均明显低于对照组[(21.42±3.44) mg/L、(87.60±13.56)μg/L、(75.77±21.35) ng/L、(144.60±15.20) pg/mL],差异均有统计学意义(P<0.05)。与手术后即刻比较,两组患者手术后6、12、24 h的RSS评分、VAS评分均逐渐降低,差异均有统计学意义(P<0.05);手术后6、12、24 h,两组患者的RSS评分、VAS评分比较差异均无统计学意义(P>0.05)。手术后1周,两组患者的血清OPG、RANKL含量均高于手术后1 d,且观察组患者的血清OPG、RANKL含量分别为(188.86±21.47)、(108.37±10.43) pg/mL,均高于对照组[(177.75±19.23)、(98.76±8.26) pg/mL],差异均有统计学意义(P<0.05)。观察组患者的术后并发症发生率为8.00%,明显低于对照组(32.00%),差异有统计学意义(P<0.05)。结论 超前镇痛方案能够促进跟骨关节内骨折患者OPG/RANKL信号通路因子表达及患者术后康复,提高镇痛效果,减少术后并发症的发生。

Micro-CT分析跟骨内骨小梁分布及结构特征

背景:跟骨位于足的后下部,受力较大。跟骨外形复杂且不规则,外周有较薄的皮质骨包绕,内部充满大量的骨小梁,探讨骨小梁的微观结构、走行及分布特征有助于提高对跟骨骨折的认识。目的:采用微计算机断层扫描仪(Micro-CT)扫描跟骨标本获得其影像资料,对其内部骨小梁结构进行分析,探讨跟骨内骨小梁的形态、分布及结构特征。方法:采用Micro-CT连续扫描干燥成人跟骨标本,扫描后获得影像图像,将其以DICOM格式存储。导入影像资料到Hiscan Analyzer软件,显示清晰完整的成人跟骨矢状面、冠状面、水平面的图像,逐层观察骨小梁的走行,依据骨小梁走行特点将跟骨矢状面分为6个部分,在以7 mm为标准的相同厚度下,每个部分选择1个49 mm2等面积的兴趣区,三维重建后获得跟骨及骨小梁的立体微观结构,二值化后运用软件计算感兴趣区域内骨小梁的体积分数、表面密度、骨小梁厚度、骨小梁间隙和骨小梁数量参数。结果与结论:①跟骨表面皮质层很薄,内部充满大量骨松质,在Gissane角的骨皮质明显增厚;②跟骨上部的骨小梁体积分数大于跟骨下部前端、中和三角区、跟骨下后部、跟骨结节部、跟骨底部,跟骨结节部的骨小梁体积分数大于跟骨下部前端、中和三角区、跟骨下后部、跟骨底部;跟骨结节部的骨小梁表面密度大于跟骨下部前端、中和三角区、跟骨底部,跟骨上部、跟骨下后部的骨小梁表面密度大于中和三角区;跟骨上部的骨小梁厚度大于跟骨结节部;中和三角区的骨小梁间隙大于跟骨上部、跟骨结节部;跟骨结节部的骨小梁数量大于中和三角区;③中和三角区主要分布杆状骨小梁,骨小梁表面密度最小、体积分数较小、骨小梁间隙最大;该部位骨质较疏松,受到高冲击力时抗压缩能力差,骨小梁最先发生断裂,是易发生骨折的部位。

黄连解毒汤加减治疗跟骨骨折术前肿胀的临床研究

目的:观察黄连解毒汤加减治疗跟骨骨折术前肿胀的临床疗效和安全性,并探讨其可能的作用机制。方法:将符合要求的70例SandersⅡ~Ⅳ型跟骨骨折患者随机分为2组,每组35例。2组患者入院后均给予石膏托外固定制动、抬高患肢、静脉滴注甘露醇注射液、皮下注射那屈肝素钙等常规治疗。常规治疗组在此基础上口服地奥司明片,每次0.9 g,每日1次,晚餐后服用,共服用7 d;黄连解毒汤组在常规治疗基础上口服黄连解毒汤加减,早晚各1次,共服用7 d。比较2组患者的患肢肿胀率、疼痛视觉模拟量表(visual analogue scale,VAS)评分、血清C反应蛋白(C-reactive protein,CRP)水平、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平、血清白细胞介素-6(interleukin 6,IL-6)水平、中医证候积分及并发症发生情况。结果:①患肢肿胀率。2组患者的患肢肿胀率随时间变化均呈先升高后降低的趋势(F=246.771,P=0.000;F=282.982,P=0.000);治疗前2组患者患肢肿胀率的差异无统计学意义(t=0.596,P=0.553);治疗第3天和治疗第7天,黄连解毒汤组患者的患肢肿胀率均低于常规治疗组(t=2.147,P=0.035;t=2.799,P=0.007)。②疼痛VAS评分。2组患者的疼痛VAS评分随时间变化均呈逐渐降低的趋势(F=262.877,P=0.000;F=462.471,P=0.000);治疗前2组患者疼痛VAS评分的差异无统计学意义(t=0.432,P=0.667);治疗第3天和治疗第7天,黄连解毒汤组患者的疼痛VAS评分均低于常规治疗组(t=3.200,P=0.002;t=8.735,P=0.000)。③血清CRP水平。2组患者的血清CRP水平随时间变化均呈先升高后降低的趋势(F=1355.001,P=0.000;F=2271.167,P=0.000);治疗前2组患者血清CRP水平的差异无统计学意义(t=-0.470,P=0.570);治疗第3天和治疗第7天,黄连解毒汤组患者的血清CRP水平均低于常规治疗组(t=4.575,P=0.000;t=25.065,P=0.000)。④血清TNF-α水平。2组患者的血清TNF-α水平随时间变化均呈先升高后降低的趋势(F=366.536,P=0.000;F=811.863,P=0.000);治疗前2组患者血清TNF-α水平的差异无统计学意义(t=-1.019,P=0.312);治疗第3天和治疗第7天,黄连解毒汤组患者的血清TNF-α水平均低于常规治疗组(t=3.222,P=0.002;t=17.223,P=0.000)。⑤血清IL-6水平。2组患者的血清IL-6水平随时间变化均呈先升高后降低的趋势(F=895.505,P=0.000;F=1184.801,P=0.000);治疗前2组患者血清IL-6水平的差异无统计学意义(t=1.606,P=0.113);治疗第3天和治疗第7天,黄连解毒汤组患者的血清IL-6水平均低于常规治疗组(t=4.432,P=0.000;t=9.249,P=0.000)。⑥中医证候积分。治疗前2组患者的中医证候积分比较,差异无统计学意义(t=-0.595,P=0.554);治疗第7天,2组患者的中医证候积分均较治疗前减小(t=24.128,P=0.000;t=40.200,P=0.000);治疗第7天黄连解毒汤组的中医证候积分低于常规治疗组(t=9.272,P=0.000)。⑦并发症。2组各有2例患者发生下肢深静脉血栓,应用那屈肝素钙联合华法林治疗1周后血栓变小或吸收;黄连解毒汤组2例发生胃肠道不适、常规治疗组2例出现皮疹,均未予药物治疗,症状自行消失。2组患者并发症发生率的差异无统计学意义(χ^(2)=0.000,P=1.000)。结论:黄连解毒汤加减可有效减轻跟骨骨折患者的术前肿胀和疼痛,而且具有较高的安全性,其作用机制可能与其降低患者血清炎症因子水平有关。

Allgower-Donati缝合法与Donati缝合法在跟骨骨折手术中临床疗效的Meta分析

目的通过Meta分析评价Allgower-Donati缝合法与Donati缝合法在跟骨骨折手术中的应用效果。方法通过建立检索式,对中国知网、维普期刊网、万方数据库、FMRS、PubMed等中英文数据库进行检索,检索时间段从数据库建立到2023年6月,将与跟骨骨折缝合方法相关的文献纳入调查研究,并使用Cochrane工具对纳入分析的文献进行文献质量评估。使用Review Manager 5.4软件对数据进行分析,比较两种缝合方法在跟骨骨折手术中的临床疗效,包括手术时间、切口缝合时间、引流管留置时间、切口愈合时间、术后切口瘢痕大小和术后VAS评分。结果共纳入13篇文献,Meta分析结果:手术时间、术口愈合时间、术后VAS评分的差异无统计学意义;切口缝合时间[OR=-0.50,95%CI为(-0.92,-0.08),P=0.02]、引流管留置时间[OR=-0.07,95%CI为(-0.13,-0.01),P=0.03]、术后切口瘢痕大小[OR=-0.42,95%CI为(-0.83,0.01),P=0.04]差异具有统计学意义。结论在跟骨骨折术口缝合方式上Allgower-Donati缝合法的临床疗效中优于Donati缝合法。

Clinical observation of biomimetic mineralized collagen artificial bone putty for bone reconstruction of calcaneus fracture

This study investigated clinical outcomes of biomimetic mineralized collagen artificial bone putty for bone reconstruction in the treatment of calcaneus fracture.Sixty cases of calcaneal fractures surgically treated with open reduction and internal fixation in our hospital from June 2014–2015 were chosen and randomly divided into two groups,including 30 cases treated with biomimetic mineralized collagen artificial bone putty as treatment group,and 30 cases treated with autogenous ilia as control group.The average follow-up time was 17.263.0 months.The results showed that the surgery duration and postoperative drainage volume of treatment group were significantly lower than control group;there were no statistically significant differences in the fracture healing time,American Orthopaedic Foot and Ankle Society scores at 3 and 12 months after surgery,Bo¨hler’s angle,Gissane’s angle and height of calcaneus between the two groups.There were no significant differences in wound complication and reject reaction between the two groups,while significant difference in donor site complication.As a conclusion,the implantation of biomimetic mineralized collagen artificial bone putty in the open reduction of calcaneal fracture resulted in reliable effect and less complications,which is suitable for clinical applications in the treatment of bone defect in calcaneal fractures.

3D打印镜像对比技术在sandersⅡ型跟骨骨折中应用的安全性及临床疗效

目的探索3D打印镜像对比技术在sandersⅡ型跟骨骨折中应用的安全性检验及其临床疗效评价。方法回顾性分析2014年5月~2021月10月,承德医学院附属医院手足外科收治的46例sandersⅡ型跟骨骨折患者。按照术前方案制定的方法,分为镜像对比技术组(23例),放射学技术组(23例)。取镜像对比技术组患侧、健侧的足舟状骨、第五跖骨的测量数据,进行对称性分析,评价其安全性。记录2组术前指标、围手术期及随访指标等评价临床效果。结果镜像对比技术组的患侧、健侧的测量数据,2组比较差异均无统计学意义(P>0.05),应用镜像对比技术实施术前规划具有安全性;手术前计划相关费用、手术前计划相关时间、骨折复位时间,2组间比较差异均有统计学意义(P<0.05)。患者均获得随访,随访时间9~15个月,平均随访(12.48±2.26)个月,骨折愈合率2组间比较差异有统计学意义(P<0.05),Maryland足功能评分2组间比较差异无统计学意义(P>0.05)。结论3D打印镜像对比技术在sandersⅡ型跟骨骨折中应用,具有安全性及可靠性,临床疗效确切,但会增加患者的经济及时间负担。

移位跟骨关节内骨折手术方法的进展与选择

跟骨骨折是临床较为常见的后足损伤,多为高处坠落所致,占全身骨折的1%~2%^([1]),占足踝部骨折的60%,分为关节内骨折和关节外骨折,其中75%为关节内骨折^([2])。目前研究表明,移位的关节内骨折手术治疗是适当的,虽然文献中关于跟骨骨折的最佳治疗方法存在许多争议,但毫无疑问的是,成功的关节复位和重建正常的跟骨结构对良好的临床疗效至关重要^([3])。

骨科机器人辅助经皮空心钉与切开复位内固定治疗SandersⅡ/Ⅲ型跟骨骨折的疗效对比

目的比较骨科机器人辅助经皮空心钉内固定与切开复位内固定治疗跟骨骨折的疗效。方法2022年1月至2023年1月间北京积水潭医院创伤骨科连续收治的新鲜跟骨骨折患者32例。根据手术方式分为骨科机器人辅助经皮空心钉内固定组(RA)(18例)和传统切开复位内固定组(ORIF)(14例);其中RA组采用闭合复位或结合跗骨窦入路辅助闭合复位,门诊复查、随访3个月。比较两组患者手术时间、术中出血量、术中透视次数、住院时间、术后影像学指标(跟骨长度、宽度、高度,Böhler角)、术后并发症、术后3个月美国足踝学会踝与后足功能评分(AOFAS)。结果与ORIF组相比,RA组患者的中位手术时间更短[63.0(48.8,90.0)min比86.0(64.8,95.0)min,Z=1.722,P=0.085];RA组患者的术中出血量低于ORIF组[5.0(3.0,6.0)ml比16.0(11.5,19.3)ml,Z=4.698,P<0.001]。RA组术中透视次数少于ORIF组[3.5(3.0,6.0)次比9.0(7.0,9.3)次,Z=4.444,P<0.001]。RA组的住院时间短于ORIF组[5.0(3.0,6.0)d比6.0(4.0,8.0)d,Z=2.152,P=0.031]。术后3个月随访时两组患者之间的跟骨宽度、跟骨高度和跟骨Böhler角差异均无统计学意义(均P>0.05);但两组患者跟骨宽度均较术前减小,跟骨高度均较术前增加,跟骨Böhler角均较术前增加(均P<0.001)。ORIF组有5例(35.7%)出现皮肤坏死、3例(21.4%)发生术后切口感染,RA组患者均未发生;两组之间差异有统计学意义(P=0.027,0.022)。RA组患者的AOFAS对线评分高于ORIF组[(7.2±1.4)分比(6.1±1.4)分,t=2.322,P=0.027]。RA组患者的AOFAS总分高于ORIF组[(84.2±5.5)分比(79.2±6.2)分,t=2.423,P=0.022]。结论骨科机器人辅助经皮空心钉内固定治疗SanderⅡ/Ⅲ型跟骨骨折安全有效,有利于缩短住院时间,减少术中出血、术中透视次数及术后并发症的发生。

跟骨骨囊肿病灶范围与病理性骨折的生物力学关系分析

目的探究跟骨孤立性骨囊肿(solitary bone cyst,SBC)病灶范围与病理性骨折的关系,为SBC治疗提供参考。方法基于CT图像建立足踝三维有限元模型,在病灶好发区构建4种梯度球型骨缺损模型,模拟不同的SBC病灶范围,分析步态周期不同时相跟骨的生物力学特征。结果在步态周期下,随着SBC范围增加,跟骨位移无明显变化,但峰值应力逐渐增大。当SBC直径超过跟骨宽度的75%时,跟骨沟和病灶下方皮质区域应力增加到正常跟骨的1.48倍和7.74倍。结论当SBC直径超过跟骨宽度的75%时,应力性骨折风险增大,可早期手术干预。跟骨沟和SBC下方骨皮质是应力集中区,可作为评估应力性骨折的重点区域。

接骨七厘胶囊联合跗骨窦切口入路钢板内固定术治疗跟骨骨折的效果

目的:探讨接骨七厘胶囊联合跗骨窦切口入路钢板内固定术治疗跟骨骨折的效果。方法:选取2018年1月—2022年1月北京市朝阳区双桥医院收治的100例跟骨骨折患者。根据随机数表法将其分为单一治疗组及联合治疗组,各50例。单一治疗组接受跗骨窦切口入路钢板内固定术治疗,联合治疗组接受接骨七厘胶囊联合跗骨窦切口入路钢板内固定术治疗。比较两组切口及骨折愈合指标、治疗6周后足功能、治疗前及治疗6周后相关指标及并发症。结果:联合治疗组切口干燥时间、切口愈合时间及骨折愈合时间均短于单一治疗组,差异有统计学意义(P<0.05)。联合治疗组优良率高于单一治疗组,差异有统计学意义(P<0.05)。治疗6周后,两组跟骨结节关节角(Bohler角)和跟骨交叉角(Gissane角)均增大,跟骨宽度降低,联合治疗组Bohler角、Gissane角均大于单一治疗组,跟骨宽度低于单一治疗组,差异有统计学意义(P<0.05)。联合治疗组并发症发生率(2.00%)低于单一治疗组(14.00%),差异有统计学意义(P<0.05)。结论:接骨七厘胶囊联合跗骨窦切口入路钢板内固定术治疗跟骨骨折可促进足功能恢复,促进骨折愈合,效果优异。