[1]陈俊杰,李铭雄,魏志勇,等.经皮克氏针撬拨复位支架外固定联合横向空心钉内固定与跗骨窦入路锁定钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的对比研究[J].中医正骨,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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经皮克氏针撬拨复位支架外固定联合横向空心钉内固定与跗骨窦入路锁定钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年08期
页码:
25-30
栏目:
临床研究
出版日期:
2022-08-20

文章信息/Info

作者:
陈俊杰; 李铭雄; 魏志勇; 孔祥标; 余福钦; 陈王
(泉州市正骨医院,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
关键词:
跟骨;  骨折固定术;  临床试验
Keywords:
calcaneus;  fracture fixation;  clinical trial
摘要:
目的:比较经皮克氏针撬拨复位支架外固定联合横向空心钉内固定与跗骨窦入路锁定钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效和安全性。方法:回顾性分析42例SandersⅡ、Ⅲ型跟骨骨折患者的病例资料,其中采用经皮克氏针撬拨复位支架外固定联合横向空心钉内固定治疗20例(联合固定组)、采用跗骨窦入路锁定钢板内固定治疗22例(锁定钢板内固定组)。比较2组患者的手术时间、住院时间; 提取患者术前及术后1周X线片,测量并比较2组患者术前及术后1周跟骨形态指标(跟骨宽度、跟骨高度、B?hler角及Gissane角); 比较2组患者术后12个月美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及并发症发生率。结果:①一般指标。联合固定组患者的手术时间、住院时间均短于锁定钢板内固定组[(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跟骨形态指标。2组患者术前及术后1周跟骨高度、跟骨宽度、B?hler角、Gissane角比较,组间差异均无统计学意义[术前:(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; 术后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组患者术后1周跟骨高度、B?hler角和Gissane角均大于术前(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),跟骨宽度均小于术前(t=5.318,P=0.000; t=4.305,P=0.000)。③AOFAS踝与后足评分。联合固定组获随访17例,锁定钢板内固定组获随访21例。2组患者术后12个月AOFAS踝与后足评分比较,差异无统计学意义[(85.59±11.97)分,(87.57±10.59)分,Z=-0.458,P=0.647]。④并发症发生率。联合固定组1例术后针道疼痛明显,调整支架松紧度后疼痛缓解; 1例针道持续渗出,1例针道浅表感染,予以加强换药、口服抗生素、拆除支架后针道愈合良好。锁定钢板内固定组2例术后出现切口边缘皮肤坏死,1例切口皮下血肿合并浅表感染,予以加强换药、口服抗生素处理,切口均愈合良好。2组患者均未发生血管神经损伤、固定物松动、骨折延迟愈合、踝关节功能障碍等并发症。2组患者并发症发生率比较,差异无统计学意义(χ2=0.000,P=1.000)。结论:采用经皮克氏针撬拨复位支架外固定联合横向空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折,与跗骨窦入路锁定钢板内固定比较,二者在恢复跟骨正常形态和踝关节功能方面疗效相当,安全性也相当,但前者手术时间和住院时间短,更符合微创手术与快速康复的理念。
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 本文编辑:吕宁)

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