跗骨窦切口空心螺钉内固定治疗对SandersⅢ型跟骨骨折患者Bohler角、Gissane角、跟骨高度与宽度的影响
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摘要
目的探讨跗骨窦切口空心螺钉内固定治疗对SandersⅢ型跟骨骨折患者Bohler角、Gissane角、跟骨高度和宽度的影响。方法回顾性分析60例SandersⅢ型跟骨骨折患者的临床资料,根据手术方式分为A组(跗骨窦切口空心螺钉内固定治疗) 32例和B组(外侧L型切口钢板内固定治疗) 28例。比较2组手术时间、住院时间、骨折愈合时间及手术前后Bohler角、Gissane角、跟骨高度和宽度的变化,以Maryfand评分评价术后3个月2组患者的足踝功能恢复情况,比较2组术后并发症发生率。结果 A组手术时间、住院时间及骨折愈合时间均显著短于B组(P <0. 05); A组术后3个月的Bohler角、Gissane角及跟骨高度显著大于B组,跟骨宽度显著小于B组(P <0. 05); A组术后3个月Maryfand评分及优良率显著高于B组(P <0. 05);A组并发症发生率6. 25%,显著低于B组25. 00%(P <0. 05)。结论应用跗骨窦切口空心螺钉内固定治疗SandersⅢ型跟骨骨折患者,可明显缩短手术时间,改善Bohler角、Gissane角及跟骨高度、宽度,促进骨折复位及术后足踝功能的恢复。
Objective To explore the effect of hollow screw internal fixation of tarsal sinus incision on the Bohler angle,Gissane angle,calcaneus height and width in patients with Sanders typeⅢ calcaneal fractures. Methods The clinical data of 60 patients with Sanders Ⅲ calcaneal fractures in our hospital were retrospectively analyzed. According to the different surgical methods,they were divided into group A( hollow screw internal fixation of tarsal sinus incision,n = 32) and group B( lateral L-shaped incision and plate fixation,n = 28). The operative time,hospital stay,fracture healing time,and the changes of Bohler angle,Gissane angle,calcaneus height and width before and after operation were compared between the two groups,and the ankle function recovery at 3 months after operation was evaluated in the two groups by Maryfand score,and the incidence rate of postoperative complications was recorded in the two groups. Results The operative time,hospital stay and fracture healing time in group A were all significantly shorter than that in group B( P < 0. 05). The Bohler angle,Gissane angle and calcaneus height in group A were significantly higher than that in group B at3 months after operation,and the calcaneus width was significantly less than that in group B( P <0. 05). The Maryfand score and the excellent and good rate in group A were significantly higher than those in group B at 3 months after operation( P < 0. 05). The incidence rate of complications in group A was significantly lower than that in group B [6. 25% vs. 25. 00%,P < 0. 05]. Conclusion Hollow screw internal fixation of tarsal sinus incision and for patients with Sanders type Ⅲ calcaneal fracturescan significantly shorten the operative time,promote postoperative recovery,and significantly improve the Bohler angle,Gissane angle and calcaneus height and width,and promote postoperative recovery of ankle function and restoration of bone.
Objective To explore the effect of hollow screw internal fixation of tarsal sinus incision on the Bohler angle,Gissane angle,calcaneus height and width in patients with Sanders typeⅢ calcaneal fractures. Methods The clinical data of 60 patients with Sanders Ⅲ calcaneal fractures in our hospital were retrospectively analyzed. According to the different surgical methods,they were divided into group A( hollow screw internal fixation of tarsal sinus incision,n = 32) and group B( lateral L-shaped incision and plate fixation,n = 28). The operative time,hospital stay,fracture healing time,and the changes of Bohler angle,Gissane angle,calcaneus height and width before and after operation were compared between the two groups,and the ankle function recovery at 3 months after operation was evaluated in the two groups by Maryfand score,and the incidence rate of postoperative complications was recorded in the two groups. Results The operative time,hospital stay and fracture healing time in group A were all significantly shorter than that in group B( P < 0. 05). The Bohler angle,Gissane angle and calcaneus height in group A were significantly higher than that in group B at3 months after operation,and the calcaneus width was significantly less than that in group B( P <0. 05). The Maryfand score and the excellent and good rate in group A were significantly higher than those in group B at 3 months after operation( P < 0. 05). The incidence rate of complications in group A was significantly lower than that in group B [6. 25% vs. 25. 00%,P < 0. 05]. Conclusion Hollow screw internal fixation of tarsal sinus incision and for patients with Sanders type Ⅲ calcaneal fracturescan significantly shorten the operative time,promote postoperative recovery,and significantly improve the Bohler angle,Gissane angle and calcaneus height and width,and promote postoperative recovery of ankle function and restoration of bone.
引文
[1]朱学敏,唐三元,杨辉.跟骨骨折复位质量与疗效评价分析[J].中国矫形外科杂志,2014,22(6):524-527.
[2]张青山,张蜀华.两种手术治疗SandersⅡ型、Ⅲ型跟骨骨折的比较[J].实用骨科杂志,2014,20(6):515-519.
[3] Abdelazeem A,Khedr A,Abousayed M,et al. Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique[J]. International Orthopaedics,2014,38(3):601-609.
[4]唐光伟,王坤正,张二洋,等.经跗骨窦切口空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效观察[J].陕西医学杂志,2016,45(11):1503-1504.
[5]刘彬,郑兆云,马松涛.两种内固定方案治疗SandersⅢ型跟骨骨折疗效比较[J].海南医学,2016,27(21):3512-3514.
[6]侯正轩,李建波,刘宁波,等.跗骨窦联合外侧小切口治疗SandersⅢ型跟骨骨折[J].实用骨科杂志,2018,18(1):25-30.
[7]李伯州,胡牧,徐向阳,等.跗骨窦入路治疗SandersⅢ型跟骨关节内骨折[J].中华创伤骨科杂志,2014,16(12):1043-1048.
[8]戴锋,俞鹏飞,姜宏.跗骨窦小切口撬拨复位克氏针内固定治疗SandersⅢ型跟骨骨折[J].中国骨伤,2017,30(12):1080-1083.
[9]余斌,刘德印,杜晓龙,等.跗骨窦入路结合空心螺钉固定植骨治疗SandersⅡ、Ⅲ型跟骨骨折[J].临床骨科杂志,2017,20(6):746-749.
[10] Yeo J H,Cho H J,Lee K B. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures:sinus tarsi versus extensile lateral approach[J]. BMC Musculoskeletal Disorders,2015,16(1):1-7.
[11] De G R,Frima A J,Schepers T,et al. Complications following the extended lateral approach for calcaneal fractures do not influence mid-to long-term outcome[J]. Injury-international Journal of the Care of the Injured,2013,44(11):1596-1600.
[12]李刚建,赵鑫.经内外踝截骨入路可吸收螺钉或可吸收棒内固定修复距骨骨折:15例随访[J].中国组织工程研究,2014,18(48):7810-7815.
[13]张元松.跗骨窦入路空心钉内固定和外侧扩大型切口钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折比较[J].创伤外科杂志,2016,18(11):666-670.
[14]唐光伟,王坤正,张二洋,等.经跗骨窦切口空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效观察[J].陕西医学杂志,2016,45(11):1503-1504.
[15]王宝宝,王强,李旗,等.跗骨窦入路联合无头空心螺钉治疗关节内跟骨骨折的疗效分析[J].北京医学,2015,37(11):1064-1067.
[16]刘耀辉,李雪林,陈小微,等.跗骨窦小切口结合空心螺钉与L型切口结合钢板内固定治疗SandersⅢ型跟骨骨折疗效比较[J].世界复合医学,2017,3(4):9-12,16.
[17]梁伟之,高金伟,张海波,等.跗骨窦入路空心钉固定术治疗SandersⅡ型跟骨骨折[J].中华骨与关节外科杂志,2018,11(2):111-114.
[18]徐浩,张晓剑,黄晟,等.经跗骨窦小切口空心钉内固定治疗跟骨骨折疗效分析[J].中国矫形外科杂志,2017,25(12):1139-1142.
[19]吴勐,张朝,刘重,等.微创和常规手术治疗SandersⅡ型跟骨骨折的疗效对比[J].足踝外科电子杂志,2014,1(3):190-194.
[20]王松,赵刚,彭红心,等.经跗骨窦有限切口治疗跟骨关节内骨折[J].当代医学,2014,7(23):64-65.
[2]张青山,张蜀华.两种手术治疗SandersⅡ型、Ⅲ型跟骨骨折的比较[J].实用骨科杂志,2014,20(6):515-519.
[3] Abdelazeem A,Khedr A,Abousayed M,et al. Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique[J]. International Orthopaedics,2014,38(3):601-609.
[4]唐光伟,王坤正,张二洋,等.经跗骨窦切口空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效观察[J].陕西医学杂志,2016,45(11):1503-1504.
[5]刘彬,郑兆云,马松涛.两种内固定方案治疗SandersⅢ型跟骨骨折疗效比较[J].海南医学,2016,27(21):3512-3514.
[6]侯正轩,李建波,刘宁波,等.跗骨窦联合外侧小切口治疗SandersⅢ型跟骨骨折[J].实用骨科杂志,2018,18(1):25-30.
[7]李伯州,胡牧,徐向阳,等.跗骨窦入路治疗SandersⅢ型跟骨关节内骨折[J].中华创伤骨科杂志,2014,16(12):1043-1048.
[8]戴锋,俞鹏飞,姜宏.跗骨窦小切口撬拨复位克氏针内固定治疗SandersⅢ型跟骨骨折[J].中国骨伤,2017,30(12):1080-1083.
[9]余斌,刘德印,杜晓龙,等.跗骨窦入路结合空心螺钉固定植骨治疗SandersⅡ、Ⅲ型跟骨骨折[J].临床骨科杂志,2017,20(6):746-749.
[10] Yeo J H,Cho H J,Lee K B. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures:sinus tarsi versus extensile lateral approach[J]. BMC Musculoskeletal Disorders,2015,16(1):1-7.
[11] De G R,Frima A J,Schepers T,et al. Complications following the extended lateral approach for calcaneal fractures do not influence mid-to long-term outcome[J]. Injury-international Journal of the Care of the Injured,2013,44(11):1596-1600.
[12]李刚建,赵鑫.经内外踝截骨入路可吸收螺钉或可吸收棒内固定修复距骨骨折:15例随访[J].中国组织工程研究,2014,18(48):7810-7815.
[13]张元松.跗骨窦入路空心钉内固定和外侧扩大型切口钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折比较[J].创伤外科杂志,2016,18(11):666-670.
[14]唐光伟,王坤正,张二洋,等.经跗骨窦切口空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折疗效观察[J].陕西医学杂志,2016,45(11):1503-1504.
[15]王宝宝,王强,李旗,等.跗骨窦入路联合无头空心螺钉治疗关节内跟骨骨折的疗效分析[J].北京医学,2015,37(11):1064-1067.
[16]刘耀辉,李雪林,陈小微,等.跗骨窦小切口结合空心螺钉与L型切口结合钢板内固定治疗SandersⅢ型跟骨骨折疗效比较[J].世界复合医学,2017,3(4):9-12,16.
[17]梁伟之,高金伟,张海波,等.跗骨窦入路空心钉固定术治疗SandersⅡ型跟骨骨折[J].中华骨与关节外科杂志,2018,11(2):111-114.
[18]徐浩,张晓剑,黄晟,等.经跗骨窦小切口空心钉内固定治疗跟骨骨折疗效分析[J].中国矫形外科杂志,2017,25(12):1139-1142.
[19]吴勐,张朝,刘重,等.微创和常规手术治疗SandersⅡ型跟骨骨折的疗效对比[J].足踝外科电子杂志,2014,1(3):190-194.
[20]王松,赵刚,彭红心,等.经跗骨窦有限切口治疗跟骨关节内骨折[J].当代医学,2014,7(23):64-65.
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