跗骨窦小切口结合手法整复和跟骨外侧L型切口治疗跟骨关节内骨折的临床疗效(1)
[摘要] 目的 探索跗骨窦小切口结合手法整复和跟骨外侧L型切口治疗跟骨关节内骨折的临床疗效。 方法 方便选取2017年4月—2018年4月期间该院跟骨关节内骨折60例患者(实施奇偶数分组模式)，对照组的30例患者进行跟骨外侧L型切口治疗，观察组的30例患者进行跗骨窦小切口结合手法整复治疗，随后对比两组Bohlers角差值、跟骨中部宽度差值、Gissane角差值、切口长度、并发症发生率、骨折愈合时间、术中出血量、手术时间。 结果 观察组骨折愈合时间(7.45±1.33)周、术中出血量(25.78±2.61)mL、手术时间(61.48±3.22)min、切口长度(4.85±1.33)cm、并发症发生率(3.33%)、Gissane角差值(121.15±6.94)°、Bohlers角差值(31.28±3.55)°、跟骨中部宽度差值(26.38±3.23)mm、Kofoed評分(92.45±2.35)分、Maryland评分(93.16±2.41)分、优良率(96.67%)均优于对照组(t=3.235 5、31.973 9、15.013 7、12.320 3、9.016 7、t=5.514 8、11.348 2、13.344 0，56.258 4、15.423 5，χ2=10.258 2；P<0.05)。 结论 对跟骨关节内骨折患者实施跗骨窦小切口结合手法整复效果显著。
[关键词] 跗骨窦小切口；手法整复；跟骨关节内骨折
[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-0742(2019)01(b)-0062-03
[Abstract] Objective To investigate the clinical effect of small incision of the sinus sinus combined with manual manipulation and lateral incision of the calcaneus for the treatment of intra-articular calcaneal fractures. Methods 60 patients with intra-articular fractures of the calcaneus were enrolled in our hospital from April 22， 2017 to April 22， 2018. The patients in the control group were treated with L-shaped incision of the lateral calcaneal. 30 patients in the observation group underwent small incision of the sacral sinus combined with manual manipulation， and then compared the difference between the two groups of Bohlers angle， the width of the middle part of the calcaneus， the difference of the Gissane angle， the length of the incision， the incidence of complications， the time of fracture healing， The amount of intraoperative blood loss and operation time. Results The fracture healing time of the observation group was (7.45±1.33) weeks， intraoperative blood loss (25.78±2.61)mL， operation time (61.48±3.22) min， incision length (4.85±1.33) cm， and complication rate (3.33%)， Gissane angle difference (121.15±6.94)°， Bohlers angle difference (31.28±3.55)°， middle calcane width difference (26.38±3.23)mm， Kofoed score (92.45±2.35)points， Maryland score (93.16±2.41)points， the excellent and good rate (96.67%) were better than the control group (t=3.235 5， 31.973 9， 15.013 7， 12.320 3；χ2=9.016 7，t=5.514 8， 11.348 2， 13.344 0， 56.258 4， 15.423 5；χ2=10.258 2； P<0.05). Conclusion In the treatment of patients with intra-articular calcaneal fractures， the small incision of the sacral sinus combined with manual manipulation is effective.
[Key words] Small incision of the sinus sinus； Manipulation； Intra-articular fracture of the calcaneus
跟骨关节内骨折诱发因素较多，包括交通事故、重物砸伤、高处坠落等，多发于青壮年人群，属于临床常见的跗骨骨折，若干预不及时，容易累及距下关节，从而对生活质量造成严重影响，甚至可增加临床致残率[1]。目前常运用跟骨外侧L型切口手术治疗，虽然效果显著，但创伤性较大，且复位较为困难，容易影响术后恢复[2]。而随着近年来，微创理念的深入，跗骨窦小切口手术开始广泛用于临床，且能够在保证治疗效果基础上，减轻对机体创伤性，降低手术风险性，配合科学的手法整复干预，能够改善预后，降低各类并发症发生率 [3]。在2017年4月—2018年4月期间方便选取60例跟骨关节内骨折患者为实验对象，且均进行不同的治疗方案，从而进一步发现更为有效的治疗措施，报道如下。, http://www.100md.com(秦研鹏)
[关键词] 跗骨窦小切口；手法整复；跟骨关节内骨折
[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-0742(2019)01(b)-0062-03
[Abstract] Objective To investigate the clinical effect of small incision of the sinus sinus combined with manual manipulation and lateral incision of the calcaneus for the treatment of intra-articular calcaneal fractures. Methods 60 patients with intra-articular fractures of the calcaneus were enrolled in our hospital from April 22， 2017 to April 22， 2018. The patients in the control group were treated with L-shaped incision of the lateral calcaneal. 30 patients in the observation group underwent small incision of the sacral sinus combined with manual manipulation， and then compared the difference between the two groups of Bohlers angle， the width of the middle part of the calcaneus， the difference of the Gissane angle， the length of the incision， the incidence of complications， the time of fracture healing， The amount of intraoperative blood loss and operation time. Results The fracture healing time of the observation group was (7.45±1.33) weeks， intraoperative blood loss (25.78±2.61)mL， operation time (61.48±3.22) min， incision length (4.85±1.33) cm， and complication rate (3.33%)， Gissane angle difference (121.15±6.94)°， Bohlers angle difference (31.28±3.55)°， middle calcane width difference (26.38±3.23)mm， Kofoed score (92.45±2.35)points， Maryland score (93.16±2.41)points， the excellent and good rate (96.67%) were better than the control group (t=3.235 5， 31.973 9， 15.013 7， 12.320 3；χ2=9.016 7，t=5.514 8， 11.348 2， 13.344 0， 56.258 4， 15.423 5；χ2=10.258 2； P<0.05). Conclusion In the treatment of patients with intra-articular calcaneal fractures， the small incision of the sacral sinus combined with manual manipulation is effective.
[Key words] Small incision of the sinus sinus； Manipulation； Intra-articular fracture of the calcaneus
跟骨关节内骨折诱发因素较多，包括交通事故、重物砸伤、高处坠落等，多发于青壮年人群，属于临床常见的跗骨骨折，若干预不及时，容易累及距下关节，从而对生活质量造成严重影响，甚至可增加临床致残率[1]。目前常运用跟骨外侧L型切口手术治疗，虽然效果显著，但创伤性较大，且复位较为困难，容易影响术后恢复[2]。而随着近年来，微创理念的深入，跗骨窦小切口手术开始广泛用于临床，且能够在保证治疗效果基础上，减轻对机体创伤性，降低手术风险性，配合科学的手法整复干预，能够改善预后，降低各类并发症发生率 [3]。在2017年4月—2018年4月期间方便选取60例跟骨关节内骨折患者为实验对象，且均进行不同的治疗方案，从而进一步发现更为有效的治疗措施，报道如下。, http://www.100md.com(秦研鹏)