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[1]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(kāi)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):16-19.
　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(12):16-19.
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閉合復(fù)位經(jīng)皮穿針內(nèi)固定與切開(kāi)復(fù)位接骨板內(nèi)固定治療 PaleyB1型跟骨骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年12期
頁(yè)碼:
16-19
欄目:
臨床研究
出版日期:
2015-12-30

文章信息/Info

Title:
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
作者:
譚新歡; 聶偉志; 隋顯玉; 朱育林; 于蘭先
山東省文登整骨醫(yī)院,山東 文登 264400
Author(s):
TAN Xinhuan; NIE Weizhi; SUI Xianyu; ZHU Yulin; YU Lanxian
The Wendeng Osteopath Hospital,Wendeng 264400,Shandong,China
關(guān)鍵詞:
跟骨;  骨折; 閉合性;  骨折固定術(shù); 內(nèi)
Keywords:
calcaneus;  fractures; closed;  fracture fixation; internal
摘要:
目的:比較閉合復(fù)位經(jīng)皮穿針內(nèi)固定與切開(kāi)復(fù)位接骨板內(nèi)固定治療PaleyB1型跟骨骨折的臨床療效和安全性。方法:回顧性分析2011年2月至2014年4月收治的120例PaleyB1型跟骨骨折患者的病例資料,60例采用閉合復(fù)位經(jīng)皮穿針內(nèi)固定治療(經(jīng)皮穿針組),其余60例采用切開(kāi)復(fù)位接骨板內(nèi)固定治療(接骨板組)。比較2組患者的手術(shù)時(shí)間、住院時(shí)間、住院費(fèi)用、Böhler角、Gissane角、并發(fā)癥及臨床療效。結(jié)果:120例患者均獲隨訪(fǎng),隨訪(fǎng)時(shí)間53～66周,中位數(shù)57.5周。所有患者骨折均達(dá)到解剖復(fù)位或接近解剖復(fù)位。經(jīng)皮穿針組的手術(shù)時(shí)間、住院時(shí)間及住院費(fèi)用均低于接骨板組[(32.24±6.57)min,(67.57±9.32)min,t=15.324,P=0.000;(7.45±1.32)d,(21.50±2.63)d,t=8.459,P=0.000;(5213.42±743.89)元,(12 392.87±1984.32)元,t=18.996,P=0.000]。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=5.957,P=0.039); 2組Böhler角比較,總體上差異無(wú)統(tǒng)計(jì)學(xué)意義,不存在分組效應(yīng)(t=4.605,P=0.053); 術(shù)前、術(shù)后1 d、術(shù)后3個(gè)月、術(shù)后1年,2組Böhler角比較組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(16.56°±4.62°),(17.10°±5.01°),t=5.167,P=0.697;(33.49°±3.28°),(33.38°±3.24°),t=2.891,P=0.419;(32.78°±2.64°),(32.94°±3.17°),t=3.007,P=0.694;(32.54°±3.76°),(32.89°±3.58°),t=3.835,P=0.091]; 時(shí)間因素與分組因素不存在交互效應(yīng)(F=5.585,P=0.176)。手術(shù)前后不同時(shí)間Gissane角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=4.598,P=0.036); 2組Gissane角比較,總體上差異無(wú)統(tǒng)計(jì)學(xué)意義,不存在分組效應(yīng)(t=3.519,P=0.067); 術(shù)前、術(shù)后1 d、術(shù)后3個(gè)月、術(shù)后1年,2組Gissane角比較組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(82.74°±12.10°),(82.44°±12.34°),t=6.583,P=0.761;(132.48°±5.38°),(132.59°±5.53°),t=3.597,P=0.833;(132.83°±5.41°),(131.97°±5.55°),t=3.654,P=0.657;(131.57°±5.61°),(131.91°±5.43°),t=4.421,P=0.564]; 時(shí)間因素與分組因素不存在交互效應(yīng)(F=5.697,P=0.375)。術(shù)后1年,采用Maryland足功能評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)療效,經(jīng)皮穿針組優(yōu)21例、良32例、可7例,接骨板組優(yōu)23例、良31例、可6例; 2組患者臨床療效比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-4.308,P=0.147)。2組患者并發(fā)癥發(fā)生率比較,組間差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.240,P=0.624)。結(jié)論:閉合復(fù)位經(jīng)皮穿針內(nèi)固定和切開(kāi)復(fù)位接骨板內(nèi)固定均為治療PaleyB1型跟骨骨折的有效術(shù)式,二者的臨床療效和安全性相當(dāng),但閉合復(fù)位經(jīng)皮穿針內(nèi)固定具有手術(shù)時(shí)間短、住院天數(shù)少、治療費(fèi)用低及創(chuàng)傷小等優(yōu)點(diǎn),值得臨床推廣應(yīng)用。
Abstract:
Objective:To compare the clinical curative effects and safety 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.Methods:The medical records of 120 patients with Paley type B1 calcaneal fracture from February 2011 to April 2014 were analyzed retrospectively.Sixty patients(percutaneous wire group)were treated with closed reduction and percutaneous internal fixation with Kirschner wire,while the others(bone plate group)were treated with open reduction and internal fixation with bone plate.The operative time,hospital stays,cost of hospitalization,Böhler angle,Gissane angle,postoperative complications and clinical curative effects were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 53-66 weeks with a median of 57.5 weeks,and all fractures reached anatomical reduction or nearly anatomical reduction.The operative time,hospital stays and cost of hospitalization were less in percutaneous wire group compared to bone plate group(32.24+/-6.57 vs 67.57+/-9.32 min,t=15.324,P=0.000; 7.45+/-1.32 vs 21.50+/-2.63 days,t=8.459,P=0.000; 5213.42+/-743.89 vs 12392.87+/-1984.32 RMB,t=18.996,P=0.000).There was statistical difference in the Böhler angle between different timepoints,in other words,there was time effect(F=5.957,P=0.039).In general,there was no statistical difference in the Böhler angle between the 2 groups,in other words,there was no group effect(t=4.605,P=0.053).There was no statistical difference in the Böhler angle between the 2 groups before the operation and at 1 day,3 months and 1 year after the operation(16.56+/-4.62 vs 17.10+/-5.01 degrees,t=5.167,P=0.697; 33.49+/-3.28 vs 33.38+/-3.24 degrees,t=2.891,P=0.419; 32.78+/-2.64 vs 32.94+/-3.17 degrees,t=3.007,P=0.694; 32.54+/-3.76 vs 32.89+/-3.58 degrees,t=3.835,P=0.091).There was no interaction between time factor and grouping factor(F=5.585,P=0.176).There was statistical difference in the Gissane angle between different timepoints,in other words,there was time effect(F=4.598,P=0.036).In general,there was no statistical difference in the Gissane angle between the 2 groups,in other words,there was no group effect(t=3.519,P=0.067).There was no statistical difference in the Gissane angle between the 2 groups at above timepoint(82.74+/-12.10 vs 82.44+/-12.34 degrees,t=6.583,P=0.761; 132.48+/-5.38 vs 132.59+/-5.53 degrees,t=3.597,P=0.833; 132.83+/-5.41 vs 131.97+/-5.55 degrees,t=3.654,P=0.657; 131.57+/-5.61 vs 131.91+/-5.43 degrees,t=4.421,P=0.564).There was no interaction between time factor and grouping factor(F=5.697,P=0.375).According to Maryland foot function score,twenty-one patients obtained an excellent result,32 good and 7 fair in the percutaneous wire group; while 23 patients obtained an excellent result,31 good and 6 fair in the bone plate group.There was no statistical difference in the total curative effect between the 2 groups(Z=-4.308,P=0.147).There was no statistical difference in postoperative complication incidences between the 2 groups(χ2=0.240,P=0.624).Conclusion:Closed reduction and percutaneous internal fixation with Kirschner wire is similar to open reduction and internal fixation with bone plate in the curative effect and safety,and both of them are effective method for treatment of Paley type B1 calcaneal fractures.However,the former has such advantages as shorter operative time,shorter hospital stay,lower cost of treatment and less injury,so it is worthy of popularizing in clinic.

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備注/Memo

備注/Memo:
2015-09-09收稿 2015-09-24修回
基金項(xiàng)目:山東省科技發(fā)展計(jì)劃項(xiàng)目(2011YD19004); 威海市科技發(fā)展計(jì)劃項(xiàng)目(2015FZA03006); 2014年國(guó)家中醫(yī)藥管理局全國(guó)名老中醫(yī)藥專(zhuān)家傳承工作室建設(shè)項(xiàng)目
更新日期/Last Update: 2015-12-30