[1]谭新欢,聂伟志,隋显玉,等.闭合复位经皮穿针内固定与切开复位接骨板内固定治疗 PaleyB1型跟骨骨折的对比研究[J].中医正骨,2015,27(12):16-19.
　TAN Xinhuan,NIE Weizhi,SUI Xianyu,et al.A retrospective trial of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):16-19.
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闭合复位经皮穿针内固定与切开复位接骨板内固定治疗 PaleyB1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27卷
期数:
2015年12期
页码:
16-19
栏目:
临床研究
出版日期:
2015-12-30

文章信息/Info

Title:
A retrospective trial of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures
作者:
谭新欢; 聂伟志; 隋显玉; 朱育林; 于兰先
山东省文登整骨医院,山东 文登 264400
Author(s):
TAN Xinhuan; NIE Weizhi; SUI Xianyu; ZHU Yulin; YU Lanxian
The Wendeng Osteopath Hospital,Wendeng 264400,Shandong,China
关键词:
跟骨;  骨折; 闭合性;  骨折固定术; 内
Keywords:
calcaneus;  fractures; closed;  fracture fixation; internal
摘要:
目的:比较闭合复位经皮穿针内固定与切开复位接骨板内固定治疗PaleyB1型跟骨骨折的临床疗效和安全性。方法:回顾性分析2011年2月至2014年4月收治的120例PaleyB1型跟骨骨折患者的病例资料,60例采用闭合复位经皮穿针内固定治疗(经皮穿针组),其余60例采用切开复位接骨板内固定治疗(接骨板组)。比较2组患者的手术时间、住院时间、住院费用、Böhler角、Gissane角、并发症及临床疗效。结果:120例患者均获随访,随访时间53～66周,中位数57.5周。所有患者骨折均达到解剖复位或接近解剖复位。经皮穿针组的手术时间、住院时间及住院费用均低于接骨板组[(32.24±6.57)min,(67.57±9.32)min,t=15.324,P=0.000;(7.45±1.32)d,(21.50±2.63)d,t=8.459,P=0.000;(5213.42±743.89)元,(12 392.87±1984.32)元,t=18.996,P=0.000]。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=5.957,P=0.039); 2组Böhler角比较,总体上差异无统计学意义,不存在分组效应(t=4.605,P=0.053); 术前、术后1 d、术后3个月、术后1年,2组Böhler角比较组间差异均无统计学意义[(16.56°±4.62°),(17.10°±5.01°),t=5.167,P=0.697;(33.49°±3.28°),(33.38°±3.24°),t=2.891,P=0.419;(32.78°±2.64°),(32.94°±3.17°),t=3.007,P=0.694;(32.54°±3.76°),(32.89°±3.58°),t=3.835,P=0.091]; 时间因素与分组因素不存在交互效应(F=5.585,P=0.176)。手术前后不同时间Gissane角的差异有统计学意义,即存在时间效应(F=4.598,P=0.036); 2组Gissane角比较,总体上差异无统计学意义,不存在分组效应(t=3.519,P=0.067); 术前、术后1 d、术后3个月、术后1年,2组Gissane角比较组间差异均无统计学意义[(82.74°±12.10°),(82.44°±12.34°),t=6.583,P=0.761;(132.48°±5.38°),(132.59°±5.53°),t=3.597,P=0.833;(132.83°±5.41°),(131.97°±5.55°),t=3.654,P=0.657;(131.57°±5.61°),(131.91°±5.43°),t=4.421,P=0.564]; 时间因素与分组因素不存在交互效应(F=5.697,P=0.375)。术后1年,采用Maryland足功能评分标准评价疗效,经皮穿针组优21例、良32例、可7例,接骨板组优23例、良31例、可6例; 2组患者临床疗效比较,差异无统计学意义(Z=-4.308,P=0.147)。2组患者并发症发生率比较,组间差异无统计学意义(χ2=0.240,P=0.624)。结论:闭合复位经皮穿针内固定和切开复位接骨板内固定均为治疗PaleyB1型跟骨骨折的有效术式,二者的临床疗效和安全性相当,但闭合复位经皮穿针内固定具有手术时间短、住院天数少、治疗费用低及创伤小等优点,值得临床推广应用。
Abstract:
Objective:To compare the clinical curative effects and safety of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures.Methods:The medical records of 120 patients with Paley type B1 calcaneal fracture from February 2011 to April 2014 were analyzed retrospectively.Sixty patients(percutaneous wire group)were treated with closed reduction and percutaneous internal fixation with Kirschner wire,while the others(bone plate group)were treated with open reduction and internal fixation with bone plate.The operative time,hospital stays,cost of hospitalization,Böhler angle,Gissane angle,postoperative complications and clinical curative effects were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 53-66 weeks with a median of 57.5 weeks,and all fractures reached anatomical reduction or nearly anatomical reduction.The operative time,hospital stays and cost of hospitalization were less in percutaneous wire group compared to bone plate group(32.24+/-6.57 vs 67.57+/-9.32 min,t=15.324,P=0.000; 7.45+/-1.32 vs 21.50+/-2.63 days,t=8.459,P=0.000; 5213.42+/-743.89 vs 12392.87+/-1984.32 RMB,t=18.996,P=0.000).There was statistical difference in the Böhler angle between different timepoints,in other words,there was time effect(F=5.957,P=0.039).In general,there was no statistical difference in the Böhler angle between the 2 groups,in other words,there was no group effect(t=4.605,P=0.053).There was no statistical difference in the Böhler angle between the 2 groups before the operation and at 1 day,3 months and 1 year after the operation(16.56+/-4.62 vs 17.10+/-5.01 degrees,t=5.167,P=0.697; 33.49+/-3.28 vs 33.38+/-3.24 degrees,t=2.891,P=0.419; 32.78+/-2.64 vs 32.94+/-3.17 degrees,t=3.007,P=0.694; 32.54+/-3.76 vs 32.89+/-3.58 degrees,t=3.835,P=0.091).There was no interaction between time factor and grouping factor(F=5.585,P=0.176).There was statistical difference in the Gissane angle between different timepoints,in other words,there was time effect(F=4.598,P=0.036).In general,there was no statistical difference in the Gissane angle between the 2 groups,in other words,there was no group effect(t=3.519,P=0.067).There was no statistical difference in the Gissane angle between the 2 groups at above timepoint(82.74+/-12.10 vs 82.44+/-12.34 degrees,t=6.583,P=0.761; 132.48+/-5.38 vs 132.59+/-5.53 degrees,t=3.597,P=0.833; 132.83+/-5.41 vs 131.97+/-5.55 degrees,t=3.654,P=0.657; 131.57+/-5.61 vs 131.91+/-5.43 degrees,t=4.421,P=0.564).There was no interaction between time factor and grouping factor(F=5.697,P=0.375).According to Maryland foot function score,twenty-one patients obtained an excellent result,32 good and 7 fair in the percutaneous wire group; while 23 patients obtained an excellent result,31 good and 6 fair in the bone plate group.There was no statistical difference in the total curative effect between the 2 groups(Z=-4.308,P=0.147).There was no statistical difference in postoperative complication incidences between the 2 groups(χ2=0.240,P=0.624).Conclusion:Closed reduction and percutaneous internal fixation with Kirschner wire is similar to open reduction and internal fixation with bone plate in the curative effect and safety,and both of them are effective method for treatment of Paley type B1 calcaneal fractures.However,the former has such advantages as shorter operative time,shorter hospital stay,lower cost of treatment and less injury,so it is worthy of popularizing in clinic.

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备注/Memo

备注/Memo:
2015-09-09收稿 2015-09-24修回
基金项目:山东省科技发展计划项目(2011YD19004); 威海市科技发展计划项目(2015FZA03006); 2014年国家中医药管理局全国名老中医药专家传承工作室建设项目
更新日期/Last Update: 2015-12-30