跗骨窦切口空心钉和L型切口钢板内固定治疗跟骨骨折疗效比较

发布时间：2018-02-26 02:33

本文关键词： 跟骨骨折跗骨窦切口空心螺钉临床疗效　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的比较跗骨窦切口空心螺钉内固定和传统L型切口钢板内固定两种术式治疗闭合性跟骨骨折的优劣性,为探索跟骨骨折微创的治疗方式提供科学合理的临床依据。方法选取47例跟骨骨折患者进行回顾性分析,这些患者的病历资料较完善,在2014年7月至2016年12月期间于山东大学第二医院创伤骨科接受治疗。入组的患者均是闭合性跟骨骨折,分型属于SandersⅡ型、Ⅲ型,其中实验组22例采用跗骨窦切口空心螺钉内固定的手术方式治疗,对照组25例采用传统L型切口钢板螺钉内固定的手术方式进行治疗。通过测量患者手术前后跟骨结节角(Bohler角)、跟骨交叉角(Gissane角)、跟骨高度和宽度的数据并进行统计学分析,统计学处理患者住院时间、手术时间及术中出血量的相关数据,对患者术后功能进行评估,对患者住院期间及术后并发症进行对比分析,比较跗骨窦切口空心螺钉内固定和传统L型切口钢板内固定两种手术方式在治疗sanders Ⅱ、Ⅲ型跟骨骨折中的优劣性,为进一步探索跟骨骨折微创治疗的方式提供科学合理的临床依据。结果对47例患者进行随访的时间是6-13个月,平均为10个月。随访和相关数据的统计学处理结果告诉我们,在SandersⅡ、Ⅲ型跟骨骨折的治疗中,跗骨窦切口空心螺钉内固定和传统L型切口钢板内固定两种手术方式的临床疗效都能够让人满意。应用Maryland足功能评分标准对入组患者进行术后评估,实验组与对照组相比差异不明显(p=0.8540.05;p=0.9020.05);在影像学检查的相关参数方面进行对比分析,两组术后在跟骨B角恢复上无统计学差异(p=0.8210.05),两组术后在跟骨G角的恢复上有统计学差异(p=0.0040.05),但两种手术方式均能将G角恢复到正常范围之内;术后在两组之间进行对比,在跟骨高度和宽度恢复上无显著统计学差异(p=0.4570.05;p=0.1740.05);对照组25例患者中术后有4例出现切口并发症,1例出现腓肠神经症状,实验组22例患者术后无切口并发症发生,1例出现腓肠神经症状。两组术后的住院时间进行对比,差异有显著性(p=0.0010.01),对照组的住院时间明显少于实验组;两组的手术时间进行对比,差异无统计学意义(p=0.9870.05);两组患者的术中出血量进行对比,差异有统计学意义(p=0.0010.01),对照组的术中出血量明显少于实验组。结论跗骨窦切口空心螺钉内固定和传统L型切口钢板内固定两种手术方式治疗SandersⅡ、Ⅲ型跟骨骨折,都能够将跟骨的解剖参数恢复到正常范围之内,都能够较好的恢复患足功能。传统L型切口钢板内固定的治疗方式目前应用广泛,能够很好的恢复跟骨解剖参数,并且手术方式成熟可靠,仍是一种重要的跟骨骨折治疗手段。但跗骨窦切口空心螺钉内固定的手术方式治疗跟骨骨折具有明确的手术创伤小、术中出血少、并发症少、住院时间短等优点,同样能将跟骨解剖参数矫正至正常范围,能够很好的恢复患足功能,是一种微创、可靠、值得推广的治疗SandersⅡ、Ⅲ型闭合性跟骨骨折的方式。
[Abstract]:Objective to compare the advantages and disadvantages of tarsal sinus incision and cannulated screw internal fixation and traditional L type incision and internal fixation in two kinds of surgical treatment of closed calcaneal fracture, to provide a clinical basis for scientific and reasonable to explore the minimally invasive treatment of calcaneal fracture. Methods Retrospective analysis of 47 patients with calcaneal fractures, the medical records of the patients more perfect in the period from July 2014 to December 2016, received treatment in the Department of orthopedics of the second hospital of Shandong University. The trauma patients were closed calcaneal fracture, type Sanders belongs to type II, III, the experimental group of 22 patients with fixation of tarsal sinus bone incision hollow screw in treatment, the control group of 25 patients with fixation the traditional L type incision screws for treatment. The patients were measured before and after the surgery calcaneal angle (Bohler angle), calcaneal cross angle (Gissane angle), calcaneal height and width of the number According to the statistical analysis and statistical treatment, hospitalization time, data amount of bleeding and operation time. To evaluate the function of patients after analyzed during hospitalization and patients with postoperative complications, compare the sinus tarsi incision and cannulated screw internal fixation and conventional plate fixation of type L incision surgery in two the treatment of Sanders II, the advantages and disadvantages of type III calcaneal fractures, provide a clinical basis for scientific and reasonable to further explore the minimally invasive treatment of calcaneal fractures. Results 47 patients were followed up time was 6-13 months, with an average of 10 months. The results were followed up and the relevant data tells us that in the Sanders II. Treatment of type III calcaneal fracture, the clinical curative effect of two surgical fixation of tarsal sinus incision and cannulated screw internal fixation and traditional L type incision plate can be satisfactory. The application of Maryland The foot function evaluation standard for evaluation of the group of patients after surgery, the experimental group and the control group compared with no significant difference (p=0.8540.05; p=0.9020.05); comparative analysis on the related parameters of imaging examination, two groups of postoperative B angle of calcaneus restoration had no statistical difference (p= 0.8210.05), two groups have statistics the difference in the G angle of calcaneus recovery (p=0.0040.05), but the two kinds of operation mode can be restored to the normal range of G angle; comparison between the two groups after operation in the calcaneal height and width of no significant difference (p= recovery 0.4570.05; p=0.1740.05); 25 patients in the control group after operation incision complications occurred in 4 cases, 1 cases of sural nerve symptoms, 22 cases of experimental group patients without incision complications occurred in 1 cases, the sural nerve symptoms. The hospitalization time of the two groups were compared, there were significant differences (p=0.0010.01), the control group. Hospital time was significantly less than the experimental group; the operation time for the two groups were compared, the difference was not statistically significant (p=0.9870.05); the two groups of patients with intraoperative bleeding were compared, the difference was statistically significant (p=0.0010.01), the amount of bleeding in the control group were significantly less than the experimental group. The fixed two surgical methods of tarsal sinus incision hollow screw internal fixation and traditional L type incision plate in the treatment of Sanders II, III type of calcaneal fractures, can calcaneal anatomic parameters returned to normal range, can restore foot function. The traditional L type incision plate internal fixation treatment is currently widely used, can be a very good recovery calcaneal anatomical parameters and the mode of operation, mature and reliable, is still an important means of treatment of calcaneal fractures. But the fixation of tarsal sinus incision cannulated screws in treatment of calcaneal fracture with surgical trauma is clear, operation It has advantages of less bleeding, less complications and shorter hospitalization time. It can also straighten the calcaneal anatomical parameters to the normal range, and it can restore the function of the feet well. It is a minimally invasive, reliable and worthy of promotion for the treatment of Sanders II and III closed calcaneal fractures.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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