摘要
目的 探讨钉中钉系统髓内固定治疗SandersⅡ-Ⅲ型跟骨骨折的临床疗效。方法 选取2020年10月至2022年10月在武汉科技大学附属华润武钢总医院住院治疗并获随访的80例SandersⅡ-Ⅲ型闭合性跟骨骨折患者,根据手术方式的不同分为髓内组(采用钉中钉系统髓内固定治疗,40例)和钢板组(采用传统钢板内固定治疗,40例)。比较两组患者的手术情况(手术时间、术中透视次数、术中失血量、住院时间和骨折愈合时间)、影像学指标(跟骨B?hler角、Gissane角,跟骨宽度、高度和内外翻角度)、临床疗效[疼痛视觉模拟量表(VAS)评分、美国矫形外科足踝协会(AOFAS)评分、优良率]及术后并发症发生情况。结果 髓内组患者的手术时间、术中透视次数、术中失血量、住院时间和骨折愈合时间均少于钢板组,差异有统计学意义(P<0.05)。术后6个月两组患者的跟骨B?hler角、Gissane角、跟骨高度和内外翻角度较术前增加,跟骨宽度较术前降低,差异均有统计学意义(P<0.05),但以上影像学指标两组间比较差异均无统计学意义(P>0.05)。髓内组患者术后2 d的VAS评分低于钢板组,术后6个月的AOFAS评分和优良率高于钢板组,差异均有统计学意义(P<0.05)。髓内组术后并发症发生率(5.0%)低于钢板组(25.0%),差异有统计学意义(P<0.05)。结论 钉中钉系统髓内固定治疗SandersⅡ-Ⅲ型跟骨骨折可恢复根骨的解剖结构,且具有手术时间短、术中透视次数少、术中失血量少、骨折愈合时间短、术后切口并发症少等优势,值得临床应用。
Objective To analyze the clinical effect of nail-in-nail intramedullaryfixation in the treatment of SandersⅡ-Ⅲcalcaneal fracture.Method The data of 80 patients with closed calcaneal fracture(SandersⅡ-Ⅲtype)who were treated and followed up from October 2020 to October 2022 were retrospectively analyzed.According to different surgical methods,the patients receiving nail-in-nail intramedullaryfixation were classified into intramedullary group(40 cases)and those receiving traditional plate internalfixation were classified into plate group(40 cases).The surgical status,imaging indexes,clinical efficacy indexes[visual analogue scale of pain(VAS),American orthopaedic foot and ankle society(AOFAS),excellent and good rate]and postoperative complications were compared.Result The operation time,intraoperative fluoroscopy times,intraoperative blood loss,hospital stay and fracture healing time in intramedullary group were all lower than those in plate group(P<0.05).Böhler angle,Gissane angle,calcaneal bone height and internal and external inversion angle were increased in both groups 6 months after surgery,while calcaneal bone width was decreased compared with that before surgery(P<0.05),but there was no statistical significance between two groups(P>0.05).The VAS score of the intramedullary group was lower than that of the plate group,and the AOFAS score and the good and good rate of the intramedullary group were higher than that of the plate group 6 months after surgery(P<0.05).The incidence of postoperative complications in intramedullary group(5.00%)was lower than that in plate group(25.00%,P<0.05).Conclusion Nail-in-nail intramedullaryfixation in the treatment of SandersⅡ-Ⅲcalcaneal fracture can restore the anatomical structure of the root bone,and has the advantages of short operation time,fewer intraoperative fluoroscopy times,less intraoperative blood loss,short fracture healing time,and fewer postoperative incision complications,which is worthy of promotion.
作者
明晨
王承良
郑凯夫
陈金武
Ming Chen;Wang Chengiang;Zheng Kaifu;Chen Jinwu(Department of Orthopedics,China Resources Wuhan Iron and Steel General Hospital Affiliated to Wuhan University of Science and Technology,Wuhan Hubei 430000,China)
出处
《中国医刊》
CAS
2024年第1期60-64,共5页
Chinese Journal of Medicine
基金
武汉市医学科研项目(WX20Z07)。
关键词
跟骨骨折
钉中钉系统髓内固定
跗骨窦入路钢板内固定
Calcaneal fracture
Nailing system intramedullaryfixation
Tarsal sinus approach plate internalfixation
