切开复位、撬拨复位内固定术治疗成人Sanders Ⅲ型跟骨骨折疗效对比

摘要

Objective To compare the clinical efficacy and complications between percutaneous poking fixation and open reduction internal fixation in the treatment of adult Sanders III calcaneal fracture. Methods 36 dull Sanders III cal-caneal fracture cases were divided into group A and B,18 each. Cases in group A and B were treated with poking reduction and open reduction. Fracture healing was evaluated by imaging. Foot function after 1 a was evaluated by Maryland assessment scoring system. Statistics incidence of complications on wound dehiscence, traumatic arthritis, heel pain and impingement syndrome were compared between two group. Results Followup with a duration ranged from 10 to 15 months after the operation, with the mean of 12 months. All patients with fractures of the calcaneus bone healed. Xray was done to determine B? hler angle and Gissane angle, the group B showed better recovery in all indexes than group A(P<0.05). Maryland score was done to evaluate excellent rate, group B showed better (P < 0. 05 ) . There were 5 cases of wound dehiscence in group B, substantially higher than group A( P < 0. 05 ) . There were 5 cases of traumatic arthritis, 7 cases of heel pain and 5 cases of fibula impingement syndrome, substantially lower than group A(P<0.05). Conclusions Open reduction and internal fixation can better recover the Bohler angle and Gissane angle, facture healing and functional recovery of the foot are better, it may be the applicable method for treating Sanders III calcaneal fracture if related complications such as wound dehiscence are prevented effectively.rna%目的 比较撬拨复位、切开复位内固定术治疗成人Sanders Ⅲ型跟骨骨折的临床疗效.方法 Sanders Ⅲ型跟骨骨折36例,随机分为A、B组,各18例,分别采用撬拨复位内固定术、切开复位内固定术治疗.根据术后影像学检查结果评价骨折愈合情况,采用Maryland足功能评分系统评价患者术后1 a足部功能,计算并比较切口裂开、创伤性关节炎、跟痛及腓骨撞击综合征的发生率.结果 两组患者手术均获得成功.随访10 ～ 15个月,平均12个月,患者骨折均愈合.按Maryland足部功能评分标准,A组优4例、良7例、可2例、差5例、优良率61.11％,B组分别为10、5、2、1例和83.33％,两组优良率相比,P＜0.05.A组术后Bohler角23.22°±4.78°,Gissane角119.83°±6.18°,B组分别为29.39°±3.09°和131.11°±5.18°,A组均小于B组,P均＜0.05.术后A组无1例切口裂开,B组5例,通过定期换药后均愈合,无感染.A组出现创伤性关节炎5例、跟痛7例、腓骨撞击综合征5例,B组仅出现1例跟痛.结论 与采用撬拨复位内固定术相比,采用切开复位内固定术治疗成人Sanders Ⅲ型跟骨骨折,术后跟骨Bohler角、Gissane角及足功能恢复良好,并发症较少,但需要避免切口裂开.