[1]谭新欢,毕宏政,聂伟志,等.SandersⅡ型跟骨骨折手法复位克氏针 内固定术中植骨的临床研究[J].中医正骨,2015,27(06):6-11.
　TAN Xinhuan,BI Hongzheng,NIE Weizhi,et al.Clinical research on bone grafting after manipulative reduction and kirschner wire internal fixation for treatment of sandersⅡcalcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):6-11.
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SandersⅡ型跟骨骨折手法复位克氏针 内固定术中植骨的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年06期
页码:
6-11
栏目:
临床研究
出版日期:
2015-06-30

文章信息/Info

Title:
Clinical research on bone grafting after manipulative reduction and kirschner wire internal fixation for treatment of sandersⅡcalcaneal fractures
作者:
谭新欢; 毕宏政; 聂伟志; 杨茂清; 于兰先; 朱育林
山东省文登整骨医院,山东 文登 264400
Author(s):
TAN Xinhuan; BI Hongzheng; NIE Weizhi; YANG Maoqing; YU Lanxian; ZHU Yulin
The Wendeng osteopath hospital,Wendeng 264400,Shandong,China
关键词:
骨折; 闭合性;  跟骨;  骨折固定术; 内;  骨移植;  回顾性研究
Keywords:
fractures; closed;  calcaneus;  fracture fixation; internal;  bone transplantation;  retrospective studies
摘要:
目的:探讨SandersⅡ型跟骨骨折经手法复位克氏针内固定治疗后植骨治疗的必要性。方法:回顾性分析2012年3月至2013 年3月收治的60例SandersⅡ型跟骨骨折患者的病例资料,30例采用手法复位克氏针内固定联合小切口植骨治疗(植骨组),其余30 例采用手法复位克氏针内固定治疗(非植骨组)。比较2组患者的Böhler角、跟骨后距关节面台阶高度及临床综合疗效。结 果:60例患者均获随访,随访时间24～61周,中位数56.5周。所有骨折均达到解剖复位或近解剖复位。术后未发生感染、切口皮肤 坏死、克氏针松动及断裂等并发症。手术前后不同时间Böhler角的差异有统计学意义,即存在时间效应(F=6.000,P=0.017) 。2组Böhler角比较,总体上差异有统计学意义,即存在分组效应(F=2.530,P=0.038)。术前、术后当天、术后12周,2组 Böhler角比较,组间差异均无统计学意义[(15.61°±4.25°),(16.50°±4.59°),t=0.324,P=0.768; (33.86°±3.55°),(33.56°±3.87°),t=2.459,P=0.336;(33.61°±2.38°), (32.87°±3.42°),t=2.996,P=0.754]; 术后24周时植骨组的Böhler角大于非植骨组[(33.47°±3.57°), (30.37°±4.26°),t=3.183,P=0.044]。时间因素与分组因素存在交互效应(F=3.384,P=0.039)。手术前后不同时间后距关 节面台阶高度的差异有统计学意义,即存在时间效应(F=3.643,P=0.041)。2组后距关节面台阶高度比较,总体上差异有统计学意 义,即存在分组效应(F=4.784,P=0.045)。术前、术后当天、术后12周,2组后距关节面台阶高度比较,组间差异均无统计学意义 [(2.15±0.88)mm,(2.05±0.90)mm,t=0.452,P=0.801;(0.22±0.14)mm,(0.24±0.16)mm,t=2.422,P=0.672; (0.39±0.13)mm,(0.46±0.18)mm,t=3.156,P=0.394]; 术后24周时植骨组的后距关节面台阶高度小于非植骨组 [(0.62±0.40)mm,(1.26±0.48)mm,t=4.075,P=0.032]。时间因素与分组因素存在交互效应(F=4.229,P=0.027)。术后 24周时,3例患者因过早负重后距关节面台阶高度增大(植骨组2例,非植骨组1例)。剔除上述患者的数据后,植骨组无后距关节面 台阶高度>1 mm的病例,非植骨组中14例后距关节面台阶高度>1 mm,其骨缺损量为(2.30±0.71)cm3,经计 算其单侧95%下限为1.96 cm3。术后48周时按照张铁良等的疗效标准评定,植骨组优9例、良14例、可5例,非植骨组 优5例、良15例、可7例、差2例,2组患者的疗效比较,差异无统计学意义(Z=-1.581,P=0.114)。2组骨缺损量>1.96 cm3的患者疗效评分比较,术后48周时差异无统计学意义[(82.36±8.18)分,(78.17±10.96)分,Z=- 0.267,P=0.679]; 术后56周时植骨组疗效评分大于非植骨组[(81.95±6.74)分,(77.86±8.69)分,R^-植骨组 =10.50,R^-非植骨组=5.81,Z=-5.657,P=0.042]。结论:SandersⅡ型跟骨骨折采用手法复位克氏针内固定治 疗后,骨缺损量>1.96 cm3者,应进行植骨以防止跟骨后距关节面塌陷。
Abstract:
Objective:To investigate the necessity of bone grafting in the treatment of SandersⅡcalcaneal fractures after manipulative reduction and kirschner wire internal fixation.Methods:The medical records of 60 cases with SandersⅡcalcaneal fractures from March 2012 to March 2013 were analyzed retrospectively.Thirty cases were treated with manipulative reduction and kirschner wire internal fixation combined with bone grafting through small incision(bone-graft group),while the others were treated with manipulative reduction and kirschner wire internal fixation(non-bone-graft group).The two groups were compared with each other in Böhler angle,calcaneal posterior talar articular surface step height and comprehensive clinical effect.Results:All patients received a follow-up visit of 24-61 weeks with a median of 56.5 weeks,and all fractures reached anatomical reduction or nearly anatomical reduction.No complications were found such as infection,skin necrosis at the incision,loosening or rupture of Kirschner wires.There was statistical difference in Böhler angle between different time points,in other words,there was time effect (F=6.000,P=0.017).There was statistical difference in Böhler angle between the 2 groups in general,in other words,there was grouping effect(F=2.530,P=0.038).No statistical difference was found in Böhler angle between the 2 groups on preoperative day,postoperative day and at 12 weeks after the operation(15.61+/-4.25 vs 16.50+/-4.59 degrees,t=0.324,P=0.768; 33.86+/-3.55 vs 33.56+/-3.87 degrees,t=2.459,P=0.336; 33.61+/-2.38 vs 32.87+/-3.42 degrees,t=2.996,P=0.754).Böhler angle was larger in bone-graft group compared to non-bone- graft group at 24 weeks after operation(33.47+/-3.57 vs 30.37+/-4.26 degrees,t=3.183,P=0.044).There was interaction between time factor and grouping factor(F=3.384,P=0.039).There was statistical difference in posterior talar articular surface step height between different time points,indicating the existence of time effect(F=3.643,P=0.041).There was statistical difference in posterior talar articular surface step height in general,in other words,grouping effect was found(F=4.784,P=0.045).No statistical difference was found in posterior talar articular surface step height between the 2 groups on preoperative day,postoperative day and at 12 weeks after the operation(2.15+/-0.88 vs 2.05+/-0.90 mm,t=0.452,P=0.801; 0.22+/-0.14 vs 0.24+/-0.16 mm,t=2.422,P=0.672; 0.39+/-0.13 vs 0.46+/-0.18 mm,t=3.156,P=0.394).The posterior talar articular surface step height was lower in bone-graft group compared to non-bone-graft group at 24 weeks atter the operation(0.62+/- 0.40 vs 1.26+/-0.48 mm,t=4.075,P=0.032).There were interaction between time factor and grouping factor (F=4.229,P=0.027).The posterior talar articular surface step height increased in 3 cases at 24 weeks after the operation because of premature weight-bearing(2 cases in bone-graft group and 1 case in non-bone-graft group).Excluding above cases,other patients' posterior talar articular surface step height was less than 1 mm in bone-graft group; while in non-bone-graft group,there were 14 cases whose posterior talar articular surface step height was more than 1 mm and the volume of bone defect was 2.30+/-0.71 cm(3)which lower limit of 95% CI was 1.96 cm(3)in one-sided test.According to Zhang Tieliang's efficacy evaluation standard,9 patients obtained an excellent result,14 good and 5 fair in bone-graft group,while 5 patients obtained an excellent result,15 good,7 fair and 2 poor in non-bone-graft group at 48 weeks after operation.There was no statistical difference in curative effects between the 2 groups(Z=-1.581,P=0.114).No statistical difference was found in curative effect scores between 2 group of patients whose volume of bone defect was larger than 1.96 cm(3)at 48 weeks after the operation(82.36+/-8.18 vs 78.17+/-10.96 points,Z=-0.267,P=0.679).At 56 weeks after the operation,the curative effect score was greater in bone-graft group compared to non-graft bone group(81.95+/-6.74 vs 77.86+/-8.69 points,R^-bone-graft group=10.50 vsR^-non-bone-graft group=5.81,Z=- 5.657,P=0.042).Conclusion:In order to prevent the collapse of calcaneal posterior talar articular surface,bone grafting should be performed on patients whose volumn of bone defect is more than 1.96 cm(3)after manipulative reduction and kirschner wire internal fixation in the treatment of SandersⅡcalcaneal fractures.

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备注/Memo

备注/Memo:
2014-11-27收稿 2015-01-06修回
通讯作者:谭新欢 E-mail:txh0631@163.com
更新日期/Last Update: 2015-06-30