84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]譚新歡,畢宏政,聶偉志,等.SandersⅡ型跟骨骨折手法復(fù)位克氏針 內(nèi)固定術(shù)中植骨的臨床研究[J].中醫(yī)正骨,2015,27(06):6-11.
　TAN Xinhuan,BI Hongzheng,NIE Weizhi,et al.Clinical research on bone grafting after manipulative reduction and kirschner wire internal fixation for treatment of sandersⅡcalcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):6-11.
點(diǎn)擊復(fù)制

SandersⅡ型跟骨骨折手法復(fù)位克氏針 內(nèi)固定術(shù)中植骨的臨床研究()
分享到：

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

卷:
第27卷
期數(shù):
2015年06期
頁碼:
6-11
欄目:
臨床研究
出版日期:
2015-06-30

文章信息/Info

Title:
Clinical research on bone grafting after manipulative reduction and kirschner wire internal fixation for treatment of sandersⅡcalcaneal fractures
作者:
譚新歡; 畢宏政; 聶偉志; 楊茂清; 于蘭先; 朱育林
山東省文登整骨醫(yī)院,山東 文登 264400
Author(s):
TAN Xinhuan; BI Hongzheng; NIE Weizhi; YANG Maoqing; YU Lanxian; ZHU Yulin
The Wendeng osteopath hospital,Wendeng 264400,Shandong,China
關(guān)鍵詞:
骨折; 閉合性;  跟骨;  骨折固定術(shù); 內(nèi);  骨移植;  回顧性研究
Keywords:
fractures; closed;  calcaneus;  fracture fixation; internal;  bone transplantation;  retrospective studies
摘要:
目的:探討SandersⅡ型跟骨骨折經(jīng)手法復(fù)位克氏針內(nèi)固定治療后植骨治療的必要性。方法:回顧性分析2012年3月至2013 年3月收治的60例SandersⅡ型跟骨骨折患者的病例資料,30例采用手法復(fù)位克氏針內(nèi)固定聯(lián)合小切口植骨治療(植骨組),其余30 例采用手法復(fù)位克氏針內(nèi)固定治療(非植骨組)。比較2組患者的Böhler角、跟骨后距關(guān)節(jié)面臺(tái)階高度及臨床綜合療效。結(jié) 果:60例患者均獲隨訪,隨訪時(shí)間24～61周,中位數(shù)56.5周。所有骨折均達(dá)到解剖復(fù)位或近解剖復(fù)位。術(shù)后未發(fā)生感染、切口皮膚 壞死、克氏針?biāo)蓜?dòng)及斷裂等并發(fā)癥。手術(shù)前后不同時(shí)間Böhler角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=6.000,P=0.017) 。2組Böhler角比較,總體上差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=2.530,P=0.038)。術(shù)前、術(shù)后當(dāng)天、術(shù)后12周,2組 Böhler角比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(15.61°±4.25°),(16.50°±4.59°),t=0.324,P=0.768; (33.86°±3.55°),(33.56°±3.87°),t=2.459,P=0.336;(33.61°±2.38°), (32.87°±3.42°),t=2.996,P=0.754]; 術(shù)后24周時(shí)植骨組的Böhler角大于非植骨組[(33.47°±3.57°), (30.37°±4.26°),t=3.183,P=0.044]。時(shí)間因素與分組因素存在交互效應(yīng)(F=3.384,P=0.039)。手術(shù)前后不同時(shí)間后距關(guān) 節(jié)面臺(tái)階高度的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=3.643,P=0.041)。2組后距關(guān)節(jié)面臺(tái)階高度比較,總體上差異有統(tǒng)計(jì)學(xué)意 義,即存在分組效應(yīng)(F=4.784,P=0.045)。術(shù)前、術(shù)后當(dāng)天、術(shù)后12周,2組后距關(guān)節(jié)面臺(tái)階高度比較,組間差異均無統(tǒng)計(jì)學(xué)意義 [(2.15±0.88)mm,(2.05±0.90)mm,t=0.452,P=0.801;(0.22±0.14)mm,(0.24±0.16)mm,t=2.422,P=0.672; (0.39±0.13)mm,(0.46±0.18)mm,t=3.156,P=0.394]; 術(shù)后24周時(shí)植骨組的后距關(guān)節(jié)面臺(tái)階高度小于非植骨組 [(0.62±0.40)mm,(1.26±0.48)mm,t=4.075,P=0.032]。時(shí)間因素與分組因素存在交互效應(yīng)(F=4.229,P=0.027)。術(shù)后 24周時(shí),3例患者因過早負(fù)重后距關(guān)節(jié)面臺(tái)階高度增大(植骨組2例,非植骨組1例)。剔除上述患者的數(shù)據(jù)后,植骨組無后距關(guān)節(jié)面 臺(tái)階高度>1 mm的病例,非植骨組中14例后距關(guān)節(jié)面臺(tái)階高度>1 mm,其骨缺損量為(2.30±0.71)cm3,經(jīng)計(jì) 算其單側(cè)95%下限為1.96 cm3。術(shù)后48周時(shí)按照張鐵良等的療效標(biāo)準(zhǔn)評(píng)定,植骨組優(yōu)9例、良14例、可5例,非植骨組 優(yōu)5例、良15例、可7例、差2例,2組患者的療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=-1.581,P=0.114)。2組骨缺損量>1.96 cm3的患者療效評(píng)分比較,術(shù)后48周時(shí)差異無統(tǒng)計(jì)學(xué)意義[(82.36±8.18)分,(78.17±10.96)分,Z=- 0.267,P=0.679]; 術(shù)后56周時(shí)植骨組療效評(píng)分大于非植骨組[(81.95±6.74)分,(77.86±8.69)分,R^-植骨組 =10.50,R^-非植骨組=5.81,Z=-5.657,P=0.042]。結(jié)論:SandersⅡ型跟骨骨折采用手法復(fù)位克氏針內(nèi)固定治 療后,骨缺損量>1.96 cm3者,應(yīng)進(jìn)行植骨以防止跟骨后距關(guān)節(jié)面塌陷。
Abstract:
Objective:To investigate the necessity of bone grafting in the treatment of SandersⅡcalcaneal fractures after manipulative reduction and kirschner wire internal fixation.Methods:The medical records of 60 cases with SandersⅡcalcaneal fractures from March 2012 to March 2013 were analyzed retrospectively.Thirty cases were treated with manipulative reduction and kirschner wire internal fixation combined with bone grafting through small incision(bone-graft group),while the others were treated with manipulative reduction and kirschner wire internal fixation(non-bone-graft group).The two groups were compared with each other in Böhler angle,calcaneal posterior talar articular surface step height and comprehensive clinical effect.Results:All patients received a follow-up visit of 24-61 weeks with a median of 56.5 weeks,and all fractures reached anatomical reduction or nearly anatomical reduction.No complications were found such as infection,skin necrosis at the incision,loosening or rupture of Kirschner wires.There was statistical difference in Böhler angle between different time points,in other words,there was time effect (F=6.000,P=0.017).There was statistical difference in Böhler angle between the 2 groups in general,in other words,there was grouping effect(F=2.530,P=0.038).No statistical difference was found in Böhler angle between the 2 groups on preoperative day,postoperative day and at 12 weeks after the operation(15.61+/-4.25 vs 16.50+/-4.59 degrees,t=0.324,P=0.768; 33.86+/-3.55 vs 33.56+/-3.87 degrees,t=2.459,P=0.336; 33.61+/-2.38 vs 32.87+/-3.42 degrees,t=2.996,P=0.754).Böhler angle was larger in bone-graft group compared to non-bone- graft group at 24 weeks after operation(33.47+/-3.57 vs 30.37+/-4.26 degrees,t=3.183,P=0.044).There was interaction between time factor and grouping factor(F=3.384,P=0.039).There was statistical difference in posterior talar articular surface step height between different time points,indicating the existence of time effect(F=3.643,P=0.041).There was statistical difference in posterior talar articular surface step height in general,in other words,grouping effect was found(F=4.784,P=0.045).No statistical difference was found in posterior talar articular surface step height between the 2 groups on preoperative day,postoperative day and at 12 weeks after the operation(2.15+/-0.88 vs 2.05+/-0.90 mm,t=0.452,P=0.801; 0.22+/-0.14 vs 0.24+/-0.16 mm,t=2.422,P=0.672; 0.39+/-0.13 vs 0.46+/-0.18 mm,t=3.156,P=0.394).The posterior talar articular surface step height was lower in bone-graft group compared to non-bone-graft group at 24 weeks atter the operation(0.62+/- 0.40 vs 1.26+/-0.48 mm,t=4.075,P=0.032).There were interaction between time factor and grouping factor (F=4.229,P=0.027).The posterior talar articular surface step height increased in 3 cases at 24 weeks after the operation because of premature weight-bearing(2 cases in bone-graft group and 1 case in non-bone-graft group).Excluding above cases,other patients' posterior talar articular surface step height was less than 1 mm in bone-graft group; while in non-bone-graft group,there were 14 cases whose posterior talar articular surface step height was more than 1 mm and the volume of bone defect was 2.30+/-0.71 cm(3)which lower limit of 95% CI was 1.96 cm(3)in one-sided test.According to Zhang Tieliang's efficacy evaluation standard,9 patients obtained an excellent result,14 good and 5 fair in bone-graft group,while 5 patients obtained an excellent result,15 good,7 fair and 2 poor in non-bone-graft group at 48 weeks after operation.There was no statistical difference in curative effects between the 2 groups(Z=-1.581,P=0.114).No statistical difference was found in curative effect scores between 2 group of patients whose volume of bone defect was larger than 1.96 cm(3)at 48 weeks after the operation(82.36+/-8.18 vs 78.17+/-10.96 points,Z=-0.267,P=0.679).At 56 weeks after the operation,the curative effect score was greater in bone-graft group compared to non-graft bone group(81.95+/-6.74 vs 77.86+/-8.69 points,R^-bone-graft group=10.50 vsR^-non-bone-graft group=5.81,Z=- 5.657,P=0.042).Conclusion:In order to prevent the collapse of calcaneal posterior talar articular surface,bone grafting should be performed on patients whose volumn of bone defect is more than 1.96 cm(3)after manipulative reduction and kirschner wire internal fixation in the treatment of SandersⅡcalcaneal fractures.

參考文獻(xiàn)/References:

[1] 任錕,孫永強(qiáng),和艷紅,等.跟骨解剖支持板治療跟骨骨折48例[J].中醫(yī)正骨,2011,23(1):43-44.
[2] 溫建民.跟骨骨折的治療策略[J].中醫(yī)正骨,2013,25(4):3-6.
[3] 段軍富,張紅敏,王博,等.切開復(fù)位跟骨鈦板內(nèi)固定治療跟骨關(guān)節(jié)內(nèi)骨折[J].中醫(yī)正骨,2011,23(1):45.
[4] 姚太順.跟骨骨折的手術(shù)治療[J].中醫(yī)正骨,2011,23(12):27-29.
[5] 陳劍,丁曉,史風(fēng)雷,等.小切口跟骨鎖定鋼板外置治療跟骨骨折[J].中醫(yī)正骨,2013,25(4):49-50.
[6] 劉長松,王波.107例跟骨骨折術(shù)后療效及并發(fā)癥淺析[J].中華創(chuàng)傷骨科雜志,2011,13(8):793-795.
[7] Wang Q,Chen W,Su Y,et al.Minimally invasive treatment of calcaneal fracture by percutaneous leverage,anatomical plate,and compression bolts—the clinical evaluation of cohort of 156 patients[J].J Trauma,2010,69(6):1515-1522.
[8] Levine DS,Helfet DL.An introduction to the minimally invasive osteosynthesis of intra-articular calcaneal fractures[J].Injury,2001,32(Suppl 1):SA51-SA54.
[9] 羅亞平,Wang QY,管志海,等.外側(cè)小切口復(fù)位鋼板固定治療跟骨關(guān)節(jié)內(nèi)骨折[J].實(shí)用骨科雜志,2008,14(7):401-403.
[10] 費(fèi)爽明,吳世良,張開坤.手法復(fù)位加克氏針石膏固定治療SandersⅡ型跟骨骨折30例[J].中醫(yī)正骨,2013,25(2):61-62.
[11] Sanders R,Gregory P.Operative treatment of intra-articular fractures of the calcaneus[J].Orthop Clin North Am,1995,26(2):203-2014.
[12] 國家中醫(yī)藥管理局.中醫(yī)病證診斷療效標(biāo)準(zhǔn)[S].南京:南京大學(xué)出版社,1994:173.
[13] 張鐵良,于建華.跟骨關(guān)節(jié)內(nèi)骨折[J].中華骨科雜志,2000,20(2):52-55.
[14] Rammelt S,Gavlik JM,Barthel S,et al.The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures[J].Foot Ankle Int,2002,23(10):906-916.
[15] 俞光榮,燕曉宇.新鮮跟骨骨折的治療[J].中華創(chuàng)傷骨科雜志,2007,9(12):1173-1178.
[16] 萬海云,郭征,付軍,等.不同顆粒大小β-TCP植骨材料對(duì)于修復(fù)腔隙性骨缺損的影響[J].中國骨與關(guān)節(jié)損傷雜志,2010,25 (7):602-605.

相似文獻(xiàn)/References:

[1]王 強(qiáng).脛腓下聯(lián)合骨牽引配合手法整復(fù)小夾板外固定治療 兒童閉合移位性股骨干骨折[J].中醫(yī)正骨,2015,27(10):15.
[2]茆軍,張惠法,嚴(yán)培軍,等.Ilizarov外固定支架結(jié)合克氏針固定治療Pilon骨折[J].中醫(yī)正骨,2015,27(10):32.
[3]伍輝國,江克羅,張文正,等.手法復(fù)位杉樹皮小夾板固定治療兒童閉合性指骨骨折[J].中醫(yī)正骨,2015,27(10):63.
[4]孫群周.組合式外固定器固定結(jié)合有限內(nèi)固定治療 GustiloⅢ型脛骨開放性骨折[J].中醫(yī)正骨,2015,27(09):25.
[5]譚新歡,聶偉志,隋顯玉,等.閉合復(fù)位經(jīng)皮穿針內(nèi)固定與切開復(fù)位接骨板內(nèi)固定治療 PaleyB1型跟骨骨折的對(duì)比研究[J].中醫(yī)正骨,2015,27(12):16.
　TAN Xinhuan,NIE Weizhi,SUI Xianyu,et al.A retrospective trial of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):16.
[6]朱旭偉,萬春友,張濤,等.外固定架固定結(jié)合髓腔內(nèi)異體骨支撐治療四肢粉碎性骨折[J].中醫(yī)正骨,2015,27(12):68.
[7]楊少輝,許紅霞,邢健昆.正骨伸筋膠囊在膝關(guān)節(jié)周圍骨折術(shù)后康復(fù)中的應(yīng)用[J].中醫(yī)正骨,2015,27(02):43.
[8]饒 俐.彩色多普勒超聲檢查在下肢深靜脈血栓診斷中的價(jià)值[J].中醫(yī)正骨,2015,27(06):23.
[9]陳利軍,田野,劉文剛,等.非典型膝關(guān)節(jié)外傷后脛骨近端隱匿性骨折的影像診斷[J].中醫(yī)正骨,2015,27(06):26.
[10]林全藝,丁振貝,陳慶運(yùn),等.彈性髓內(nèi)釘內(nèi)固定治療兒童四肢長骨干骨折[J].中醫(yī)正骨,2015,27(03):52.
[11]唐少龍,李鳳平,張維康,等.損傷控制理論在C型Pilon骨折中的應(yīng)用[J].中醫(yī)正骨,2011,23(02):14.
　TANG Shao-long*,LI Feng-ping,ZHANG Wei-kang,et al.Damage control theory in C-type pilon fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2011,23(06):14.
[12]江克羅,張文正,伍輝國,等.手法復(fù)位經(jīng)皮穿針內(nèi)固定治療掌指骨骨折[J].中醫(yī)正骨,2016,28(03):55.
[13]周智毅,王建偉,張亞峰,等.手法復(fù)位安瓿瓶塑形紙質(zhì)支架夾板固定治療閉合性環(huán)、小指指骨骨折[J].中醫(yī)正骨,2016,28(08):56.
[14]彭亮,劉雙,魏國華,等.距下關(guān)節(jié)鏡輔助下經(jīng)皮撬撥復(fù)位內(nèi)固定治療合并糖尿病的跟骨骨折[J].中醫(yī)正骨,2021,33(03):64.
　PENG Liang,LIU Shuang,WEI Guohua,et al.Percutaneous leverage reduction and internal fixation assisted by subtalar arthroscopy for treatment of calcaneal fractures combined with diabetes[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(06):64.

備注/Memo

備注/Memo:
2014-11-27收稿 2015-01-06修回
通訊作者:譚新歡 E-mail:[email protected]
更新日期/Last Update: 2015-06-30