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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期数:

2013年10期

页码:

27-30

栏目:

临床研究

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:

陈 剑

山东省青岛市骨伤科医院,山东 青岛 266021

Author(s):

Chen Jian

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

关键词:

跟骨 骨折 骨折固定术

Keywords:

Calcaneus;  Fractures; bone;  Fractures fixation

摘要:

目的:比较切开复位后锁定钢板外置与锁定钢板内置治疗跟骨骨折的临床疗效及安全性。方法:2008年6月至2011年4月,分别采用切开复位锁定钢板外置与锁定钢板内置手术治疗跟骨骨折患者45例,男37例,女8例; 年龄21～58岁,中位数42岁; 左侧19例,右侧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。采用锁定钢板外置22例,锁定钢板内置23例。观察2组患者骨折愈合及患足功能恢复情况,并对2组患者的受伤至手术时间、手术时间、切口长度、骨折愈合时间、术后并发症及疗效进行比较。结果:2组患者均顺利完成手术,受伤至手术时间、切口长度的组间比较,差异有统计学意义[(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]; 手术时间组间比较,差异无统计学意义[(50.5±15.3)min,(75.6±15.4)min; t=2.165,P=0.934)。45例患者均获随访,随访时间9～18个月,中位数12个月。骨折均愈合,愈合时间8～12周,中位数10周; 2组患者骨折愈合时间比较,差异无统计学意义[(10.0±2.0)周,(10.3±2.1)周; t=1.182,P=0.816]。参照美国足与踝关节协会踝与后足功能评分标准评价疗效,锁定钢板外置组,优14例、良6例、可1例、差1例; 锁定钢板内置组,优15例、良5例、可2例、差1例; 2组患者疗效比较,差异无统计学意义(Z=-0.013,P=0.989)。锁定钢板外置组术后并发腓肠神经损伤1例、钉道感染1例; 锁定钢板内置组术后并发切口皮缘坏死5例、腓肠神经损伤1例。2组患者术后并发症比较,差异无统计学意义(χ2=1.211,P=0.271)。结论:切开复位锁定钢板外置治疗跟骨骨折,固定可靠、有利于骨折愈合和患足功能恢复,与切开复位锁定钢板内置术的疗效和安全性相当,且对皮肤条件要求低、损伤小。

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.

备注/Memo

备注/Memo:

2012-12-27收稿 2013-05-24修回

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更新日期/Last Update: 2013-10-30