传统手法复位结合锁定钢板外置微创治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效分析

发布时间：2018-04-20 16:12

本文选题：跟骨骨折 + 锁定钢板　；参考：《江苏大学》2016年硕士论文

【摘要】：[背景]近年来,跟骨骨折尤其是涉及移位的关节内跟骨骨折损伤机制复杂,其在治疗方式上一向备受争议,外侧“L”型延长切口切开复位内固定术已成为外科手术治疗跟骨骨折的金标准,但此切口术中软组织剥离多,加之跟骨外侧局部软组织菲薄、血运较差,切口皮缘坏死不愈合及软组织感染发生率较高。随着微创理念的不断深入,越来越多的外科医师采用微创手术治疗跟骨骨折,因其可以最大程度的减轻软组织损伤,保护血供,降低切口并发症发生率。微创手术术式众多,各类微创手术治疗跟骨骨折取得了良好的临床疗效,但对于传统手法复位结合皮肤外放置锁定钢板治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究尚不够深入,其手术安全性、临床疗效及术后近远期并发症值得进一步探讨。[目的]探讨传统手法复位结合锁定钢板外置治疗Sanders Ⅱ、Ⅲ型跟骨骨折的手术安全性及效果,并分析其术后近远期并发症的发生原因及其应对策略。[方法](1)手术安全性及效果分析:选取2012年1月1日-2014年12月31日符合选择标准的52例Sanders Ⅱ、Ⅲ型跟骨骨折患者作为研究对象,随机分为两组。研究组25例以传统手法复位结合皮肤外放置锁定钢板外固定进行治疗,对照组27例采用传统的切开复位内固定进行治疗。组间比较患者性别、年龄、致伤原因等一般资料无显著统计学差异(P0.05)的基础上,比较两组手术时间、术中出血量、术中X线暴露时间、术后软组织感染评价手术安全性,比较两组术后跟骨长度、宽度、高度变化情况,Bohler角和Gissane角改善程度,骨折愈合时间及术后1年足功能评分评价手术效果。(2)术后近远期并发症分析:对上述采取传统手法复位皮外放置锁定钢板固定术式治疗的研究组25例跟骨骨折患者进行回顾性分析,随访18-36个月,平均22.4月,对术后出现钉道反应、神经损伤、腓骨长短肌腱受累、足部慢性疼痛等相关并发症进行分析,末次随访采用Maryland足功能评分评价远期疗效。[结果](1)与对照组相比,研究组手术时间短、术中出血量少、软组织感染率低,差异有统计学意义(P0.05),术中X线暴露时间无明显差异(P0.05);两种术式术前后均能明显改善跟骨的长度、高度、宽度、Bohler角和Gissane角(P0.05),改善程度无明显差异(P0.05),组间比较上述指标无明显差异(P0.05);两组均未观察到骨折延迟愈合或不愈合的病例,骨折愈合时间相同(P0.05)。术后1年,两组足功能均恢复满意,Maryland评分优良率无明显差异(P0.05)。(2)研究组25例均获随访,无失访病例,最终纳入研究25例(25足),术后随访18-36个月,平均22.4月。末次随访Maryland足功能评分优22例,良2例,中1例,差0例,Maryland总分平均分为94.5分,优良率96%。术后出现钉道反应3例,神经损伤2例,腓骨长短肌腱损伤1例,足部慢性疼痛1例。[结论](1)传统手法复位结合锁定钢板外置治疗Sanders Ⅱ、Ⅲ型跟骨骨折手术安全性高,能够取得与传统术式相同的临床效果,且手术创伤更小、手术时间更短、术后软组织感染率低,具有一定的微创优势。(2)经皮外置锁定钢板治疗Sanders Ⅱ、Ⅲ型跟骨骨折是一种有效的微创手术方式,但术后也存在一定的并发症,术前熟悉跟骨局部解剖、掌握好手术技巧以及合理的围手术期处理可以减少相关并发症发生,此外,并发症一旦发生需积极采取措施对症处理。
[Abstract]:[background] in recent years, the mechanism of calcaneal fracture, especially the transposition of intra-articular calcaneal fracture, is very complicated. It has always been controversial in the way of treatment. Lateral "L" type lengthening incision and internal fixation has become the gold standard for surgical treatment of calcaneal fracture. However, the soft tissue dissection and the lateral calcaneus of the calcaneus are more in this incision. The soft tissue is thin, the blood transport is poor, the necrosis of the incision skin necrosis and the incidence of soft tissue infection are high. With the continuous deepening of the concept of minimally invasive, more and more surgeons use minimally invasive surgery for the treatment of calcaneus fracture, because it can minimize the injury of soft tissue, protect blood supply and reduce the incidence of incision complications. Minimally invasive surgical operation Many kinds of minimally invasive surgery for the treatment of calcaneus fracture have achieved good clinical effect, but the clinical study of traditional manipulative reduction combined with locking plate outside the skin in the treatment of Sanders II and type III calcaneus fracture is not deep enough. The safety, clinical efficacy and postoperative complications of the treatment of calcaneal fractures deserve further discussion. The operation safety and effect of Sanders II, type III calcaneal fracture treated with the combination of manual reduction and locking plate, and analysis of the causes and coping strategies of the near and long term complications after the operation. [method] (1) the operation safety and effect analysis: 52 cases of Sanders II, type III, which were in accordance with the selection criteria in December 31st January 1, 2012, were selected. The patients with calcaneal fracture were randomly divided into two groups. 25 cases in the study group were treated by traditional manipulative reduction and external fixation with locking plate outside the skin, and 27 cases in the control group were treated with traditional open reduction and internal fixation. There was no significant statistical difference between the group and the general data of the patients' sex, age, and cause of injury (P0.05) On the basis of the two groups, the operation time, the amount of intraoperative bleeding, the exposure time of X-ray, the postoperative soft tissue infection evaluation of the operation safety, compared the length of the calcaneus, the width, the height, the improvement of the Bohler angle and Gissane angle after operation, the time of fracture healing and the 1 year foot function score after the operation were compared between the two groups. (2) close to long term after operation, and Analysis of hair symptoms: a retrospective analysis of 25 cases of calcaneal fracture with traditional manipulation and locking plate fixation. A follow-up of 18-36 months was followed up for an average of 22.4 months. The postoperative complications such as nail tract reaction, nerve injury, peroneal tendon involvement, and chronic pain in the foot were analyzed, and the last time was analyzed. Maryland foot function score was used to evaluate the long-term effect. [results] (1) compared with the control group, the operation time of the study group was shorter, the amount of bleeding in the operation was less, the infection rate of soft tissue was low, the difference was statistically significant (P0.05), there was no significant difference in the exposure time during the operation (P0.05), and the length, height, width, Boh of the calcaneus could be obviously improved before and after the operation. Ler angle and Gissane angle (P0.05) had no significant difference (P0.05). There was no significant difference between the two groups (P0.05). No cases of delayed union or nonunion of fracture were observed in the two groups, and the time of fracture healing was the same (P0.05). The two groups of foot function recovered satisfactorily in the 1 year after operation, and there was no significant difference in the good rate of Maryland score (P0.05). (2) study on the good rate of Maryland score. All 25 cases were followed up, with no missing cases, and 25 cases (25 feet) were included in the study. The follow-up was 18-36 months, mean 22.4 months. The last follow-up Maryland foot function score was excellent 22 cases, good 2 cases, 1 cases and 0 cases, the average score of Maryland was 94.5 points, excellent rate 96%. postoperative nailing reaction occurred in 3 cases, nerve injury 2 cases, fibula tendon injury 1 cases, foot, foot. 1 cases of chronic pain. [Conclusion] (1) the traditional manipulative reduction combined with locking plate for Sanders II and type III calcaneus fracture has high safety. It can obtain the same clinical effect as the traditional method, and the surgical trauma is smaller, the operation time is shorter, the infection rate of soft tissue is low after operation, and it has a certain minimally invasive advantage. (2) external locking steel for the percutaneous locking steel. Plate treatment of Sanders II and type III calcaneus fracture is an effective minimally invasive operation, but there are some complications after operation. Familiar with the local anatomy of the calcaneus, mastering the surgical skills and reasonable perioperative management can reduce the incidence of related complications. In addition, when the onset of the disease needs to be taken active measures to treat the disease.

【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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