| 经皮复位微创跟骨钉中钉固定治疗SandersⅡ型及Ⅲ型跟骨骨折 |
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投稿时间：2022-09-01
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| 作者 | Author | 单位 | Address | E-Mail |
| 黄杰 |
HUANG Jie |
天水市第一人民医院骨一科, 甘肃 天水 741000 |
Department of Orthopaedics, Tianshui First People's Hospital, Tianshui 741000, Gansu, China |
wwq3136@163.com |
| 刘瑾 |
LIU Jin |
天水市第一人民医院骨一科, 甘肃 天水 741000 |
Department of Orthopaedics, Tianshui First People's Hospital, Tianshui 741000, Gansu, China |
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| 张建伟 |
ZHANG Jian-wei |
天水市第一人民医院骨一科, 甘肃 天水 741000 |
Department of Orthopaedics, Tianshui First People's Hospital, Tianshui 741000, Gansu, China |
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| 期刊信息：《中国骨伤》2023年，第36卷，第4期，第313-319页 |
| DOI：10.12200/j.issn.1003-0034.2023.04.004 |
| 基金项目: |
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中文摘要:
目的： 探讨经皮复位联合跟骨钉中钉系统内固定在SandersⅡ-Ⅲ型跟骨骨折治疗中的应用效果。
方法： 自2017年7月至2019年8月,对治疗的98例SandersⅡ-Ⅲ型跟骨骨折患者的临床资料进行回顾性分析,依据手术方式不同分为观察组和对照组。观察组56例,男35例,女21例,年龄23~58(34.50±7.81)岁;骨折Sanders分型Ⅱ型29例,Ⅲ型27例;左侧30例,右侧26例;骨折至手术时间1~4(3.45±0.54) d;采用经皮复位联合跟骨钉中钉系统内固定治疗。对照组42例,男25例,女17例;年龄25~60(35.27±7.64)岁;SandersⅡ型23例,Ⅲ型19例;左侧24例,右侧18例;骨折至手术时间2~5(3.42±0.62) d;采用切开复位内固定治疗。比较两组患者手术时间、出血量、住院时间、骨折愈合时间、术后1 d视觉模拟评分(visual analogue scale,VAS)、手术前后美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分,以及手术前后Böhler角及Gissane角、跟骨宽度变化情况;并记录随访期间并发症发生情况。
结果： 所有患者获得随访,时间13~18(15.6±2.2)个月。观察组手术时间、出血量、住院时间、骨折愈合时间均优于对照组(P<0.05)。两组术后1 d VAS比较,差异有统计学意义(P<0.05)。两组术后12个月AOFAS评分比较,差异有统计学意义(P<0.05),且术后12个月较术前明显改善(P<0.05);术后12个月根据AOFAS评分,观察组优21例,良30例,可5例;对照组优10例,良22例,可7例,差3例;两组比较差异有统计学意义(P<0.05)。两组术后6个月Böhler角、Gissane角与跟骨宽度均较术前明显改善(P<0.05)。观察组1例出现术后皮肤麻木,对照组20例出现术后皮肤麻木,术后皮肤坏死14例;两组比较差异有统计学意义(P<0.01)。
结论： 与切开复位内固定治疗相比,经皮复位联合跟骨钉中钉系统内固定治疗Sanders Ⅱ-Ⅲ型跟骨骨折无须等待足部消肿即可行骨折修复手术,可准确恢复骨折后跟骨正常形态和位置,杜绝骨折畸形愈合,减少术后并发症,能缩短手术时间、住院时间、骨折愈合时间,减少出血量,促进术后恢复,且并发症少,安全性较高,可作为足踝创伤骨科手术治疗的一种选择。 |
| 【关键词】跟骨骨折 微创 髓内固定 切开复位 |
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| Treatment of Sanders typeⅡto Ⅲ calcaneal fractures with percutaneous reduction and minimally invasive calcaneal screw fixation |
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ABSTRACT
Objective To investigate clinical effect of percutaneous reduction combined with internal fixation of calcaneal nail in treating Sanders typeⅡto Ⅲ calcaneal fractures.
Methods From July 2017 to August 2019,clinical data of 98 patients with Sanders typeⅡto Ⅲ calcaneal fractures treated were retrospectively analyzed,and divided into observation group and control group according to different surgical methods. In observation group,there were 35 males and 21 females,aged from 23 to 58 years old with an average of (34.50±7.81) years old;29 patients with Sanders typeⅡand 27 patients with Sanders type Ⅲ;30 patients on the left side and 26 patients on the right side;the time from fracture to operation ranged from 1 to 4 days with an average of (3.45±0.54) days;and treated with percutaneous reduction combined with internal fixation of calcaneal nail system. In control group,there were 25 males and 17 females,aged from 25 to 60 years old with an average of (35.27±7.64) years old;23 patients with Sanders type Ⅱ and 19 patients with Sanders type Ⅲ;24 patients on the left side and 18 patients on the right side;the time from fracture to operation ranged from 2 to 5 days with an average of (3.42±0.62) days;and treated with open reduction and internal fixation. Operation time,blood loss,hospital stay,fracture healing time,and postoperative visual analogue scale (VAS) at 1 day,preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score,Böhler angle,Gissane angle and calcaneus width,and postoperative complications were compared between two groups.
Results All patients were followed up from 13 to 18 months with an average of (15.6±2.2) months. There were significant differences in operation time,blood loss,hospital stay,fracture healing time and postoperative VAS at 1 day between two groups (P<0.05). There was statistical difference in postoperative AOFAS score at 12 months between two groups (P<0.05),and AOFAS score at 12 months after operation was higher than that before operation (P<0.05). According to AOFAS score,21 patients got excellent result,30 good and 5 moderate in observation group,and 10 excellent,22 good,7 moderate and 3 poor in control group,which had statistical difference between two groups (P<0.05). Postoperative Böhler angle,Gissane angle and calcaneus width at 6 months were better than that before operation between two groups(P<0.05). One patient in observation and 20 patients in control group occurred skin numbness after operation,and 14 patients occurred skin necrosis in control group,there were obvious difference between two groups(P<0.01).
Conclusion Compared with open reduction and internal fixation,percutaneous reduction combined with internal fixation system in treating Sanders typeⅡto Ⅲ calcaneal fractures is feasible for fracture repair without waiting for foot deswelling,which could accurately restore normal shape and position of the fractured heel bone,completely eliminate fracture malunion,and reduce postoperative complications. Therefore,it could shorten operation time,hospital stay,fracture healing time,reduce amount of blood loss,promote postoperative recovery,and less complications,high safety,which could be used as a choice of orthopedic surgery for foot and ankle trauma. |
| KEY WORDS Calcaneal fracture Minimally invasive surgery Intramedullary fixation Open reduction |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黄杰,刘瑾,张建伟.经皮复位微创跟骨钉中钉固定治疗SandersⅡ型及Ⅲ型跟骨骨折[J].中国骨伤,2023,36(4):313~319 |
| 英文格式: | HUANG Jie,LIU Jin,ZHANG Jian-wei.Treatment of Sanders typeⅡto Ⅲ calcaneal fractures with percutaneous reduction and minimally invasive calcaneal screw fixation[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(4):313~319 |
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