撬拨复位外固定和切开复位内固定治疗跟骨骨折疗效分析

目的探讨经皮撬拨复位外固定和切开复位内固定治疗跟骨骨折的疗效。方法回顾分析我科自2006年5月至2011年7月治疗45例（50足）跟骨骨折的临床资料。结果所有患者均获得随访,时间为10～20个月,平均14.9个月。术后复查X线片显示跟距关节面基本恢复正常,撬拨复位外固定器固定组,Bo。hler角和Gissane角分别由术前的（9.56±6.23）°,（85.24±9.36）°恢复至术后的（32.43±7.61）°,（124.34±10.51）°;切开复位内固定组,Bo。hler角和Gissane角分别由术前的（8.29±7.47）°,（90.63±8.47）°恢复至术后的（30.49±8.06）°,（130.57±6.49）°,经统计两组之间差异无统计学意义（P〉0.05）。根据Maryland足部评分系统评价术后功能,撬拨复位外固定器固定组：优7足,良10足,中4足,差1足,优良率77.3%;切开复位内固定组：优10足,良13足,中3足,差2足,优良率82.1%,经统计两组优良率差异无统计学意义（P〉0.05）。结论这两种方法治疗跟骨骨折都是比较实用有效的选择,但应根据不同的骨折类型选择不同的治疗方法,实现治疗的个性化,才能取得良好的治疗效果,将骨折对患者术后的日常生活影响降到最低。

Clinical Effect of Percutaneous Poking Reduction and Open Reduction for Treatment of the Calcaneal Fracture

Objective To observe the clinical efficacy of percutaneous poking reduction and open reduction for treatment of the calcaneal fracture.Methods From May 2006 to July 2011,45 patients with calcaneal fractures(50 feet) were treated by percutaneous poking reduction and incision reduction.The clinical materials of those patients were analyzed retrospectively.Results These 45 patients were followed-up for 10 months to 20 months with an average of 14.9 months.The X-rays showed that the strctures of articulationes subtalaris were almost normal after operation.Group A treated by percutaneous poking reduction:the Bohler′s angle and the Gissane′s angle were improved from(9.56±6.23)°,(85.24±9.36)° before operation to(32.43±7.61)°,(124.34±10.51)° after operation respec-tively;Group B treated by open reduction:the Bohler′s angle and the Gissane′s angle were improved from(8.29±7.47)°,(90.63±8.47)°before operation to(30.49±8.06)°,(130.57±6.49)° after operation respectively.Statistical analysis indicates that there was no difference between two group(P>0.05).According to Maryland foot score sys-tem,there were excellent in 7 feet,medium good in 10 feet,in 4 feet and poor in 1 feet,excellent and good rate is 77.3% in group A.And there were excellent in 10 feet,good in 13 feet,medium in 3 feet,and poor in 2 feet,excellent and good rate is 82.1% in group B.Statistical analysis indicated that there was no difference in excellent and good rate(P>0.05).Conclusion The results of this study suggest that the two methods are effective to treat the calcaneal fracture and it is critical to choose different methods according to different fracture types.