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[1]陳俊杰,李銘雄,魏志勇,等.經(jīng)皮克氏針撬撥復位支架外固定聯(lián)合橫向空心釘內(nèi)固定與跗骨竇入路鎖定鋼板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折的對比研究[J].中醫(yī)正骨,2022,34(08):25-30.
　CHEN Junjie,LI Mingxiong,WEI Zhiyong,et al.[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(08):25-30.
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經(jīng)皮克氏針撬撥復位支架外固定聯(lián)合橫向空心釘內(nèi)固定與跗骨竇入路鎖定鋼板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年08期
頁碼:
25-30
欄目:
臨床研究
出版日期:
2022-08-20

文章信息/Info

作者:
陳俊杰; 李銘雄; 魏志勇; 孔祥標; 余福欽; 陳王
(泉州市正骨醫(yī)院,福建 泉州 362000)
Author(s):
CHEN Junjie; LI Mingxiong; WEI Zhiyong; KONG Xiangbiao; YU Fuqin; CHEN Wang
Quanzhou Orthopedic-Traumatological Hospital,Quanzhou 362000,Fujian,China
關(guān)鍵詞:
跟骨;  骨折固定術(shù);  臨床試驗
Keywords:
calcaneus;  fracture fixation;  clinical trial
摘要:
目的:比較經(jīng)皮克氏針撬撥復位支架外固定聯(lián)合橫向空心釘內(nèi)固定與跗骨竇入路鎖定鋼板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折的臨床療效和安全性。方法:回顧性分析42例SandersⅡ、Ⅲ型跟骨骨折患者的病例資料,其中采用經(jīng)皮克氏針撬撥復位支架外固定聯(lián)合橫向空心釘內(nèi)固定治療20例(聯(lián)合固定組)、采用跗骨竇入路鎖定鋼板內(nèi)固定治療22例(鎖定鋼板內(nèi)固定組)。比較2組患者的手術(shù)時間、住院時間; 提取患者術(shù)前及術(shù)后1周X線片,測量并比較2組患者術(shù)前及術(shù)后1周跟骨形態(tài)指標(跟骨寬度、跟骨高度、B?hler角及Gissane角); 比較2組患者術(shù)后12個月美國足與踝關(guān)節(jié)協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評分及并發(fā)癥發(fā)生率。結(jié)果:①一般指標。聯(lián)合固定組患者的手術(shù)時間、住院時間均短于鎖定鋼板內(nèi)固定組[(76.90±21.49)min,(123.86±34.81)min,Z=-4.317,P=0.000;(10.55±3.65)d,(13.91±4.01)d,t=-2.829,P=0.007]。②跟骨形態(tài)指標。2組患者術(shù)前及術(shù)后1周跟骨高度、跟骨寬度、B?hler角、Gissane角比較,組間差異均無統(tǒng)計學意義[術(shù)前:(38.97±3.09)mm,(39.27±3.28)mm,t=-0.307,P=0.760;(42.85±3.03)mm,(41.82±4.56)mm,t=0.854,P=0.398; 6.45°±4.20°,7.32°±4.63°,Z=-0.709,P=0.478; 103.90°±10.92°,100.59°±8.78°,t=1.087,P=0.284; 術(shù)后1周:(48.37±3.52)mm,(49.14±3.28)mm,t=-0.730,P=0.470;(37.19±3.67)mm,(36.41±3.72)mm,t=0.679,P=0.501; 28.50°±4.34°,26.68°±4.08°,t=1.401,P=0.169; 128.20°±4.74°,126.64°±5.23°,t=1.011,P=0.318]; 2組患者術(shù)后1周跟骨高度、B?hler角和Gissane角均大于術(shù)前(高度:t=-8.974,P=0.000; t=-9.965,P=0.000; B?hler角:t=-16.340,P=0.000; t=-5.643,P=0.000; Gissane角:t=-9.131,P=0.000; t=-11.951,P=0.000),跟骨寬度均小于術(shù)前(t=5.318,P=0.000; t=4.305,P=0.000)。③AOFAS踝與后足評分。聯(lián)合固定組獲隨訪17例,鎖定鋼板內(nèi)固定組獲隨訪21例。2組患者術(shù)后12個月AOFAS踝與后足評分比較,差異無統(tǒng)計學意義[(85.59±11.97)分,(87.57±10.59)分,Z=-0.458,P=0.647]。④并發(fā)癥發(fā)生率。聯(lián)合固定組1例術(shù)后針道疼痛明顯,調(diào)整支架松緊度后疼痛緩解; 1例針道持續(xù)滲出,1例針道淺表感染,予以加強換藥、口服抗生素、拆除支架后針道愈合良好。鎖定鋼板內(nèi)固定組2例術(shù)后出現(xiàn)切口邊緣皮膚壞死,1例切口皮下血腫合并淺表感染,予以加強換藥、口服抗生素處理,切口均愈合良好。2組患者均未發(fā)生血管神經(jīng)損傷、固定物松動、骨折延遲愈合、踝關(guān)節(jié)功能障礙等并發(fā)癥。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.000,P=1.000)。結(jié)論:采用經(jīng)皮克氏針撬撥復位支架外固定聯(lián)合橫向空心釘內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折,與跗骨竇入路鎖定鋼板內(nèi)固定比較,二者在恢復跟骨正常形態(tài)和踝關(guān)節(jié)功能方面療效相當,安全性也相當,但前者手術(shù)時間和住院時間短,更符合微創(chuàng)手術(shù)與快速康復的理念。
Abstract:
Objective:To compare the clinical outcomes and safety of percutaneous Kirschner-wires(K-wires)leverage reduction and frame external fixation combined with lateral hollow screw internal fixation versus locking plate internal fixation through sinus tarsal approach(STA)in treatment of Sanders typeⅡandⅢcalcaneal fractures.Methods:The medical records of 42 patients with Sanders typeⅡand Ⅲcalcaneal fractures were analyzed retrospectively.Twenty patients were treated with percutaneous K-wires leverage reduction and frame external fixation combined with lateral hollow screw internal fixation(combination fixation group)and 22 ones with locking plate internal fixation through STA(locking plate internal fixation group).The operative time and hospital stays were compared between the 2 groups.The X-ray films taken before the surgery and at postsurgical week 1 were extracted,and the calcaneal width,calcaneal height,B?hler angle and Gissane angle were compared between the 2 groups.Furthermore,the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score evaluated at postsurgical month 12 and complication incidence were compared between the 2 groups.Results:①The operative time and hospital stays were shorter in combination fixation group comapred to locking plate internal fixation group(76.90±21.49 vs 123.86±34.81 minutes,Z=-4.317,P=0.000; 10.55±3.65 vs 13.91±4.01 days,t=-2.829,P=0.007).②There was no statistical difference in presurgical and postsurgical Week-1 calcaneal height,calcaneal width,B?hler angle and Gissane angle between the 2 groups(presurgical:38.97±3.09 vs 39.27±3.28 mm,t=-0.307,P=0.760; 42.85±3.03 vs 41.82±4.56 mm,t=0.854,P=0.398; 6.45±4.20 vs 7.32±4.63 degrees,Z=-0.709,P=0.478; 103.90±10.92 vs 100.59±8.78 degrees,t=1.087,P=0.284; postsurgical week 1:48.37±3.52 vs 49.14±3.28 mm,t=-0.730,P=0.470; 37.19±3.67 vs 36.41±3.72 mm,t=0.679,P=0.501; 28.50±4.34 vs 26.68±4.08 degrees,t=1.401,P=0.169; 128.20±4.74 vs 126.64±5.23 degrees,t=1.011,P=0.318).The calcaneal height,B?hler angle and Gissane angle increased,whereas the calcaneal width decreased in the 2 groups at postsurgical week 1 comapred to pre-surgery(calcaneal height:t=-8.974,P=0.000; t=-9.965,P=0.000; B?hler angle:t=-16.340,P=0.000; t=-5.643,P=0.000; Gissane angle:t=-9.131,P=0.000; t=-11.951,P=0.000; calcaneal width:t=5.318,P=0.000; t=4.305,P=0.000).③Seventeen patients in combination fixation group and 21 ones in locking plate internal fixation group were followed up.There was no statistical difference in AOFAS ankle-hindfoot score evaluated at postsurgical month 12 between the 2 groups(85.59±11.97 vs 87.57±10.59 points,Z=-0.458,P=0.647).④The postsurgical pin-track pain(1 case)was found in combination fixation group,and it was relieved after adjusting the tension of the frame.The sustained exudation(1 case)and superficial infection(1 case)were found in combination fixation group,and the pin-track healed well after treatment with dressing change,oral application of antibiotics and removal of frame.The cutaneous necrosis around the incision(2 cases)and subcutaneous hematoma complicated with superficial infection(1 case)were found in locking plate internal fixation group,and the incisions healed well after treatment with dressing change and oral application of antibiotics.No complications such as neurovascular injury,fixator loosening,fracture delayed union and ankle dysfunction were found in the 2 groups.There was no statistical difference in complication incidence between the 2 groups(χ2=0.000,P=1.000).Conclusion:The percutaneous K-wires leverage reduction and frame external fixation combined with lateral hollow screw internal fixation is similar to locking plate internal fixation through STA in safety and curative effects on restoring calcaneal normal morphology and ankle function in treatment of Sanders typeⅡandⅢcalcaneal fractures,while the former displays the advantages of shorter operative time and hospital stays compared to the latter,which is more aligned with the concepts of minimally invasive surgery and enhanced recovery after surgery.

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(收稿日期:2022-03-25 本文編輯:呂寧)

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通訊作者:陳王 E-mail:[email protected]
更新日期/Last Update: 1900-01-01