撬拨复位结合Ilizarov技术与切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效比较-现代医学

撬拨复位结合Ilizarov技术与切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效比较

单位：承德医学院附属医院手足外科, 河北承德 067000

关键词：撬拨复位切开复位内固定术 Ilizarov技术 SandersⅡ Ⅲ型跟骨骨折微创

分类号：R683.42

出版年·卷·期（页码）：2019·47·第六期（663-667）

摘要：

目的：研究撬拨复位结合Ilizarov技术与切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效差异。方法：选取本院2015年3月至2017年12月收治的SandersⅡ、Ⅲ型跟骨骨折患者100例作为研究对象，分为观察组（50例）和对照组（50例）。观察组采用撬拨复位结合Ilizarov技术治疗，对照组采用切开复位内固定术治疗。对两组患者手术时间、术中出血量、术后住院时间、骨折愈合时间和患侧跟骨解剖参数等临床指标及踝-后足功能评分（AOFAS）情况进行对比。结果：观察组患者手术时间、术中出血量及术后住院时间均短于或少于对照组患者，差异具有统计学意义（P<0.05）；两组骨折愈合时间差异无统计学意义（P>0.05）。跟骨解剖参数显示观察组患者的Bohler角、Gissane角、轴位角及足跟宽度小于对照组，差异具有统计学意义（P<0.05）；两组足跟长度差异无统计学意义（P>0.05）。观察组患者AOFAS评分45~93分，平均（80.07±17.97）分；对照组患者AOFAS评分41~91分，平均（78.57±18.61）分。观察组优秀24例，良好21例；对照组优秀21例，良好20例。总恢复率观察组为90%，对照组为82%，两组差异无统计学意义（P>0.05）。结论：撬拨复位结合Ilizarov技术具有操作简易、术时短及微创等优点，与切开复位内固定术的治疗效果无明显差异，对于软组织条件差的SandersⅡ、Ⅲ型患者撬拨复位结合Ilizarov技术应作为首选，以减少手术创伤。

Objective:To study the curative effect of prying reduction combined with Ilizarov and open reduction and internal fixation in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Methods:100 patients with Sanders Ⅱ and Ⅲ calcaneal fractures admitted to our hospital from March 2015 to December 2017 were divided into the observation group (50 cases) and the control group (50 cases). The observation group was treated by prying reduction combined with Ilizarov technique, while the control group was treated by open reduction and internal fixation. The clinical indexes such as the operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time and anatomical parameters of the affected side and Ankle Hindfoot Scale (AOFAS) scores of the two groups were compared.Results:The operative time, intraoperative bleeding volume and postoperative hospitalization time in the observation group werelower than those in the control group, the difference was statistically significant (P<0.05), but there was no significant difference in fracture healing time between the two groups (P>0.05). The anatomical parameters of calcaneus showed that the levels of Bohler angle, axial angle and heel width in the observation group were significantly lower than those in the control group (P<0. 05), but there was no significant difference in heel length between the two groups (P>0.05). The AOFAS score of the observation group was 45-93 points, with an average of (80.07±17.97) points. The AOFAS score of the control group was 41-91 points, with an average of (78.57±18.61) points. 24 cases were excellent and 21 cases were good in the observation group,while 21 cases were excellent and 20 cases were good in control group. The overall recovery rate was 90% in the observation group and 82% in the control group,there was no significant difference between the two groups (P>0.05). Conclusion:The combination of sputum reduction and Ilizarov technique has the advantages of simple operation, short operation time and minimally invasive surgery, and there is no significant difference between the treatment effect of prying reduction combined with Ilizarov and open reduction and internal fixation. For the Sander Ⅱ and Ⅲ calcaneal fractures patients with poor soft tissue conditions prying reduction combined with Ilizarov should be the first choice to reduce the trauma of surgery on patients.

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