切开复位AO钢板内固定与透视下经皮撬拨闭合复位内固定治疗跟骨关节内骨折的临床疗效观察

目的 对比研究切开复位AO钢板内固定与透视下经皮撬拨闭合复位内固定治疗跟骨关节内骨折的疗效.方法 将112例跟骨关节内骨折患者随机分为两组:56例行切开复位AO钢板内固定作为切开组,56例行透视下经皮撬拨闭合复位内固定作为闭合组.对比两组的Maryland足部评分优良率、影像学检查结果、骨折愈合时间及并发症,并进行统计学分析.结果 切开组的Maryland足部评分优良率为92.86％,显著高于闭合组的78.57％ (P＜0.05);术后两组Bohler角及Gissane's角均显著增大(P＜0.05),跟骨中部宽度均显著降低(P＜0.05),但组间比较差异无统计学意义(P＞0.05);两组骨折愈合时间比较差异无统计学意义(P＞0.05);闭合组的并发症发生率(3.57％)与切开组(10.71％)比较差异无统计学意义(P＞0.05).结论 在临床疗效的比较方面,切开复位AO钢板内固定治疗SandersⅡ型以上跟骨关节内骨折与透视下经皮撬拨闭合复位内固定相当,但切开复位能够更好地改善足部功能,临床应根据患者及术者的具体情况合理选择术式.

Open reduction and internal fixation with AO steel plate versus fluoroscopically guided percutaneous poking close reduction and internal fixation for intra-articular calcaneal fractures

Objective To study the curative effect of open reduction and internal fixation with AO steel plate versus fluoroscopically guided percutaneous poking close reduction and internal fixation for intra-articular calcaneal fractures.Methods 112 patients with intra-articular calcaneal fractures were randomly divided into an open group, receiving open reduction and internal fixation with AO steel plate, and a close group, receiving fluoroscopically guided percutaneous poking close reduction and internal fixation.The excellent and good rate of Maryland foot evaluation, imaging results, fracture healing time, and complications of these two groups were compared and statistically analyzed.Results The excellent and good rate of Maryland foot evaluation of the open group was 92.86％, which was evidently higher than that of the close group (78.57％, P ＜0.05);after the operation, Bolher angle and Gissane's angle of both groups were increased evidently (P ＜0.05) and the calcaneus middle width of both groups decreased evidently (P ＜0.05), but with no statistical differences between these two groups (P ＞0.05);there was no statistical difference in fracture healing time between these two groups (P ＞0.05);the incidence of complications was 3.57％ in the close group and was 10.71％ the open group, with no statistical difference between these two groups (P ＞0.05).Conclusions Open reduction and internal fixation with AO steel plate for intra-articular calcaneal fractures is as effective as fluoroscopically guided percutaneous poking close reduction and internal fixation, but can better improve foot function.The doctors should clinically choose a proper operation way according to the specific conditions of patients and doctors.