两种手术方法治疗跟骨骨折的病例对照研究

目的:探讨闭合撬拨复位空心螺钉内固定与传统切开复位钢板内固定治疗跟骨骨折的临床疗效。方法:2007年8月至2010年5月,对进行闭合复位空心螺钉内固定(25例,A组)及切开复位钢板内固定(28例,B组)治疗的53例跟骨骨折患者进行回顾性分析,男35例,女18例;年龄18～67岁,平均39.1岁。Sanders骨折分型:Ⅱ型18例,Ⅲ型29例,Ⅳ型6例。分析内容包括手术时间、术中出血量、术后并发症、影像学资料及术后功能恢复情况(按照Maryland足功能评分标准)。结果:53例患者均获随访,时间9～35个月,平均20.4个月。手术时间和术中出血量A组少于B组,A组无骨折不愈合、感染及皮肤坏死病例,并发创伤性距下关节炎1例;B组3例出现局部皮肤坏死,1例骨折部位应用人工骨4个月未愈合,1例发生创伤性关节炎,无深部感染发生。末次随访时影像学表现2组无明显差异。术后功能恢复A组优8例,良12例;B组优10例,良14例。2组差异无统计学意义。结论:采用撬拨复位空心螺钉内固定治疗跟骨骨折,可获得良好的复位和可靠的固定,且在手术时间及术中出血量、术后早期局部皮肤并发症方面,较切开复位内固定治疗具有明显的优越性。

Case-control study on two methods for the treatment of calcaneal fractures

Objective:To investigate clinical results of percutaneous reduction and hollow screw internal fixation for the treatment of calcaneal fractures,and to compare therapeutic effects between close reduction hollow screw internal fixation and open reduction plate internal fixation. Methods:From August 2007 to May 2010,53 patients with calcaneal fractures were retrospectively analyzed. All the patients were divided into two groups,25 patients in group A (PR group) treated with percutaneous reduction and hollow screw internal fixation,including 17 males and 8 females,with an average age of (39.4±9.9) years. While 28 patients in group B (OR group) treated with open reduction and plate internal fixation,including 18 males and 10 females,with an average age of (38.6±10.2) years. According to Sanders classification,there were 18 patients with type Ⅱ fractures,29 patients with type Ⅲ and 6 type Ⅳ. In both groups,operative time,blood loss,postoperative complications and radiology were recorded. Functional recovery was evaluated by Maryland score. Results:All the patients were followed up,and the duration ranged from nine months to thirty-five months(averaged 20.4 months). There were no significant differences in sex,age,fracture type,fracture classification,initial Bhler angle,or late complications between the two groups. But significant difference can be seen between operative time,blood loss,and skin complications(in group A no nonunion and skin complications occurred,but subtalar posttraumatic arthritis occurred in 1 case;in group B,3 patients had complications of skin necrosis,1 patient suffered from a delayed union due to large defect filled with artificial bone,and 1 patient got subtalar posttraumatic arthritis). No difference were found in the latest X-ray film. According to Maryland score,in group A,8 got an excellent result and 12 good. In group B,10 got an excellent and 14 good. There were no significant differences between the two groups in Margland score. Conclusion:The results of this study suggest that in comparison with open reduction,percutaneous reduction and hollow screw internal fixation minimizes complications and achieves good results. Further study of this technique is needed.