CAJ | 학술논문

目的：比较经皮撬拨复位空心螺钉内固定与切开复位钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折的临床疗效，进一步探究两种手术方式的优缺点，拓展临床医师对于跟骨骨折治疗的临床思路，为科学选择手术方案提供一定的经验和参考。方法将纳入研究的2011年10月至2012年9月间56例跟骨新鲜骨折分为A、B两组：A组即经皮撬拨复位空心螺钉内固定组（撬拨组，28例），B组即切开复位钢板内固定组（切开组，28例），比较两组患者的相关观察指标：手术时间、术中出血量、切口愈合时间、住院时间、手术前后各项影像学参数、术后并发症及足部功能恢复情况（按照Maryland足部功能评分标准），而后对各项观察指标的数据进行统计学分析，以a＝0.05为检验水准，P﹤0.05为差异有统计学意义。结果56例患者均获12个月随访，两组的手术时间、术中出血量、切口愈合时间、住院时间差异有统计学意义（ P﹤0.05）；术后两组间 Bolher角及Gissane角及足部功能恢复优良率差异无统计学意义（ P﹥0.05），两组术后影像学参数较术前有明显好转（ P﹤0.05）；撬拨组足部功能评分及优良率稍高于切开组，但差异无统计学意义（ P﹥0.05），2组并发症发生率差异有统计学意义（ P﹤0.05）。结论微创经皮撬拨复位空心螺钉内固定治疗跟骨骨折（ SandersⅡ型、Ⅲ型）同样可获得良好的复位和可靠的固定，而且术中出血和术后并发症少，手术时间、切口愈合时间及住院时间较短，是治疗跟骨骨折可靠、有效、实用的手术方式。
목적：비교경피효발복위공심라정내고정여절개복위강판내고정치료SandersⅡ형、Ⅲ형근골골절적림상료효，진일보탐구량충수술방식적우결점，탁전림상의사대우근골골절치료적림상사로，위과학선택수술방안제공일정적경험화삼고。방법장납입연구적2011년10월지2012년9월간56례근골신선골절분위A、B량조：A조즉경피효발복위공심라정내고정조（효발조，28례），B조즉절개복위강판내고정조（절개조，28례），비교량조환자적상관관찰지표：수술시간、술중출혈량、절구유합시간、주원시간、수술전후각항영상학삼수、술후병발증급족부공능회복정황（안조Maryland족부공능평분표준），이후대각항관찰지표적수거진행통계학분석，이a＝0.05위검험수준，P﹤0.05위차이유통계학의의。결과56례환자균획12개월수방，량조적수술시간、술중출혈량、절구유합시간、주원시간차이유통계학의의（ P﹤0.05）；술후량조간 Bolher각급Gissane각급족부공능회복우량솔차이무통계학의의（ P﹥0.05），량조술후영상학삼수교술전유명현호전（ P﹤0.05）；효발조족부공능평분급우량솔초고우절개조，단차이무통계학의의（ P﹥0.05），2조병발증발생솔차이유통계학의의（ P﹤0.05）。결론미창경피효발복위공심라정내고정치료근골골절（ SandersⅡ형、Ⅲ형）동양가획득량호적복위화가고적고정，이차술중출혈화술후병발증소，수술시간、절구유합시간급주원시간교단，시치료근골골절가고、유효、실용적수술방식。
Objective Tocompareclinicalefficacybetweenpercutaneousreductionhollowscrewinternalfixationand openreductionplateinternalfixationinthetreatmentofSandersⅡ、Ⅲtypecalcanealfracture.Methods 6casesoffreshand unilateral SandersⅡ、Ⅲ type calcaneal fractures from October 2011 to September 2012 were divided into group A and group B. Both group has 28 cases. The cases of group A were treated with percutaneous reduction and hollow screw internal fixation, and the cases of group B were treated with open reduction and plate internal fixation. We compared the two groups of patients with correlated observation index:operation time,intraoperative blood loss,incision healing time,hospitalization time after oper-ation,the imaging parameters before and after operation,the postoperative complications and the functional recovery of foot, whichwasevaluatedbyMarylandscore.Thenthedataofobservedindexeswerestatisticallyanalyzed.Results 56patients had been followed up for 12 months,significant difference could be found between operation time,peri-operative bleeding, wound healing time and hospitalization time;postoperative Bolher angle. Gissane angle and the excellent rate of functional re-covery between the two groups had no significant difference(P﹥0. 05),two groups of postoperative radiographic parameters had obviously improved than that before operation(P﹤0. 05);the group A was slightly higher than the group B in Maryland score and the excellent rate of functional recovery,but the difference was not statistically significant(P﹥0. 05). There were significantdifferencesbetweenthetwogroupsinthecomplicationincidence(P﹤0.05).Conclusion Minimallyinvasiveper-cutaneous reduction and hollow screw internal fixation for the treatment of SandersⅡ、Ⅲ type calcaneal fracture also can ob-tain good reduction and reliable fixation,and can not only lower intraoperative bleeding and postoperative complications,but can also shorten operation time,wound healing time and hospitalization time. So it is a reliable,effective and practical operation technology in the treatment of calcaneal fracture.