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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期數(shù):

2013年10期

頁(yè)碼:

27-30

欄目:

臨床研究

出版日期:

2013-10-30

文章信息/Info

Title:

A retrospective trial of open reduction external fixation versus internal fixation with locking plate for treatment of calcaneus fractures

作者:

陳 劍

山東省青島市骨傷科醫(yī)院,山東 青島 266021

Author(s):

Chen Jian

Orthopedics and traumatology hospital of Qingdao,Qingdao 266021,Shandong,China

關(guān)鍵詞:

跟骨 骨折 骨折固定術(shù)

Keywords:

Calcaneus;  Fractures; bone;  Fractures fixation

摘要:

目的:比較切開(kāi)復(fù)位后鎖定鋼板外置與鎖定鋼板內(nèi)置治療跟骨骨折的臨床療效及安全性。方法:2008年6月至2011年4月,分別采用切開(kāi)復(fù)位鎖定鋼板外置與鎖定鋼板內(nèi)置手術(shù)治療跟骨骨折患者45例,男37例,女8例; 年齡21～58歲,中位數(shù)42歲; 左側(cè)19例,右側(cè)26例; 骨折Sanders分型,ⅡA型5例、ⅡB型11例、ⅡC型9例、ⅢAC型18例、Ⅳ型2例。采用鎖定鋼板外置22例,鎖定鋼板內(nèi)置23例。觀察2組患者骨折愈合及患足功能恢復(fù)情況,并對(duì)2組患者的受傷至手術(shù)時(shí)間、手術(shù)時(shí)間、切口長(zhǎng)度、骨折愈合時(shí)間、術(shù)后并發(fā)癥及療效進(jìn)行比較。結(jié)果:2組患者均順利完成手術(shù),受傷至手術(shù)時(shí)間、切口長(zhǎng)度的組間比較,差異有統(tǒng)計(jì)學(xué)意義[(3.1±2.5)d,(11.3±5.50)d,t=4.561,P=0.032;(5.5±2.1)cm,(15.3±2.4)cm,t=8.725,P=0.011]; 手術(shù)時(shí)間組間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(50.5±15.3)min,(75.6±15.4)min; t=2.165,P=0.934)。45例患者均獲隨訪,隨訪時(shí)間9～18個(gè)月,中位數(shù)12個(gè)月。骨折均愈合,愈合時(shí)間8～12周,中位數(shù)10周; 2組患者骨折愈合時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(10.0±2.0)周,(10.3±2.1)周; t=1.182,P=0.816]。參照美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)踝與后足功能評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)療效,鎖定鋼板外置組,優(yōu)14例、良6例、可1例、差1例; 鎖定鋼板內(nèi)置組,優(yōu)15例、良5例、可2例、差1例; 2組患者療效比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-0.013,P=0.989)。鎖定鋼板外置組術(shù)后并發(fā)腓腸神經(jīng)損傷1例、釘?shù)栏腥?例; 鎖定鋼板內(nèi)置組術(shù)后并發(fā)切口皮緣壞死5例、腓腸神經(jīng)損傷1例。2組患者術(shù)后并發(fā)癥比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=1.211,P=0.271)。結(jié)論:切開(kāi)復(fù)位鎖定鋼板外置治療跟骨骨折,固定可靠、有利于骨折愈合和患足功能恢復(fù),與切開(kāi)復(fù)位鎖定鋼板內(nèi)置術(shù)的療效和安全性相當(dāng),且對(duì)皮膚條件要求低、損傷小。

Abstract:

Objective:To compare the clinical curative effects and safety of open reduction external fixation versus internal fixation with locking plate for treatment of calcaneus fractures.Methods:Forty-five patients with calcaneus fractures were treated with open reduction external fixation(22)or internal fixation(23)with locking plate from June 2008 to April 2011.The patients consisted of 37 males and 8 females,and ranged in age from 21 to 58 years(Mean=42 yrs).The fractures located in left calcaneus for 19 patients and right calcaneus for 26 patients,and the fractures belonged to Sanders typesⅡA(5),ⅡB(11),ⅡC(9),ⅢAC(18)and Ⅳ(2).Fracture healing and foot function restoration were reviewed,and the two groups were compared with each other in such parameters as the time from injury to surgery,operative time,incision length,fracture healing time,postoperative complications and curative effect.Results:The surgery were successfully completed in all the patients.There were statistical differences in the time from injury to operation and incision length between the 2 groups(3.1+/-2.5 vs 11.3+/-5.50 days,t=4.561,P=0.032; 5.5+/-2.1 vs 15.3+/-2.4 cm,t=8.725,P=0.011).There was no statistical difference in the operative time between the 2 groups(50.5+/-15.3 vs 75.6+/-15.4 min,t=2.165,P=0.934).All patients in the 2 groups were followed up for 9-18 months with a median of 12 months,and all fractures united between 8 and 12 weeks with a median of 10 weeks.There was no statistical difference in fracture healing time between the 2 groups(10.0+/-2.0 vs 10.3+/-2.1 weeks,t=1.182,P=0.816).Fourteen patients obtained an excellent result,6 good,1 fair and 1 poor in the locking plate external fixation group according to American Orthopaedic Foot and Ankle Society(AOFAS)Ankle-Hindfoot Scale; While 15 patients obtained an excellent result,5 good,2 fair and 1 poor in the locking plate internal fixation group.There was no statistical difference in the curative effects between the 2 groups(Z=-0.013,P=0.989).Sural nerve injury(1)and nail infection(1)were reported respectively after the surgery in the locking plate external fixation group,while skin necrosis at the incision margin(5)and sural nerve injury(1)were reported respectively after the surgery in the locking plate internal fixation group.There was no statistical difference in the postoperative complications between the 2 groups(χ2=1.211,P=0.271).Conclusion:External fixation with locking plate has reliable fixation effect and it is helpful to fracture healing and foot function restoration.Open reduction external fixation with locking plate is similar to open reduction internal fixation with locking plate in curative effects and safty in the treatment of calcaneus fractures,while the former has the advantage of less requirement for skin condition and less injury.

備注/Memo

備注/Memo:

2012-12-27收稿 2013-05-24修回

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更新日期/Last Update: 2013-10-30