摘要
目的 探讨改良L形切口内固定治疗跟骨骨折的疗效.方法 将 31 例跟骨骨折患者按照切口入路不同分为改良L形切口组(采用改良L形切口内固定治疗,17 例)和跗骨窦切口组(采用跗骨窦切口内固定治疗,14 例).记录两组切口长度、术中出血量、手术时间、切口愈合等级、拆线时间、骨折愈合时间、影像学指标(Böhler角、Gissane角、跟骨高度及宽度).采用AOFAS踝-后足评分评价踝关节功能恢复情况,采用Mary-Land评分评价足部功能.结果 患者均获得随访,时间 12～24 个月.切口长度:跗骨窦切口组短于改良L形切口组(P<0.01).术中出血量、手术时间、拆线时间、切口愈合等级、切口并发症发生率、骨折愈合时间:两组比较差异均无统计学意义(P>0.05).各项影像学指标:跗骨窦切口组末次随访均较术后 3d有丢失(P<0.05);改良L形切口组末次随访均较术后3d无丢失(P>0.05);末次随访时改良L形切口组均优于跗骨窦切口组(P<0.05).AOFAS踝-后足评分、MaryLand评分:两组末次随访均高于术后3 个月(P<0.05);术后3 个月、末次随访时改良L形切口组均高于跗骨窦切口组(P<0.05).结论 改良L形切口内固定治疗跟骨骨折具有骨块显露清晰、骨折复位固定可靠、踝关节功能恢复良好的优点,临床疗效满意.
Abstract
Objective To investigate the clinical efficacy of modified L-shaped incision internal fixation for treatment of calcaneal fractures.Methods The 31 patients with calcaneal fractures were divided into the modified L-shaped in-cision group(17 cases)and the tarsal sinus incision group(14 cases),according to different incisions approaches.The incision length,intraoperative blood loss,operative time,wound healing grade,suture removal time,fracture healing time and imaging indicators(the Böhler angle,Gissane angle,calcaneal height and width)were recorded.AOFAS an-kle-hindfoot score was used to evaluate the recovery of ankle function,and MaryLand score was used to evaluate foot function.Results All patients were followed up for 12～24 months.The incision length in tarsal sinus incision group was shorter than that in modified L-shaped incision group(P<0.01).There were no statistical differences in the intr-aoperative bleeding volume,operation time,time of suture removal,wound healing grade,incidence of wound complica-tions and fracture healing time between the two groups(P>0.05).Various imaging parameters:the tarsal sinus inci-sion group had loss at the last follow-up than those of the postoperative 3 d(P<0.05),while the modified L-shaped incision group had no loss at the last follow-up than those of the postoperative 3 d(P>0.05);at the last follow-up,the modified L-shaped incision group was superior to the tarsal sinus incision group(P<0.05).AOFAS ankle-hind-foot score,MaryLand score:both groups were higher in the last follow-up than those of 3 months after surgery(P<0.05);at 3 months after operation and the last follow-up,the data of the modified L-shaped incision group were higher than those in the tarsal sinus incision group(P<0.05).Conclusions The modified L-shaped incision internal fixa-tion for treatment of calcaneal fractures has the advantages of clear exposure of bone mass,reliable fracture reduction and fixation,and good ankle joint function recovery.The clinical efficacy is satisfactory.
维普
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