两种手术方法治疗跟骨骨折的比较

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1、提要目的:探讨闭合撬拨复位克氏针固定和切开复位内固定治疗跟骨关节内骨折的临床疗效。方法:收集山东中医药大学附属医院骨科2009年12月2011年11月病房收治的符合纳入标准的跟骨骨折患者40例，分别采用闭合撬拨复位克氏针固定和切开复位内固定各20例，经治疗后观察两者术后Böhler角、Gissane’s角及患足Maryland评分等指标的差异性。结果:两组40例均获得随访，时间6-18个月，平均9个月。术后并发症比较P>0.05，无统计学差异；在术后Böhler角的恢复上，两组之间治疗后比较，P>0.05，无统计学差异；组内治疗后与治疗前比较P<0.01；Gissane’s角的恢

2、复P<0.01，有显著统计学差异；患足Maryland评分P<0.05，有统计学差异。结论:切开复位内固定跟骨关节内骨折，没有显著增加患足并发症的发生，而在术后Gissane’s角的恢复上具有显著改善，对患足功能的恢复具有显著疗效。关键词跟骨；骨折；切开复位内固定；撬拨复位ComparisonofTwoSurgicalMethodsintheTreatmentofCalcanealFractureSpeciality:OrthopedicsofTCMAuthor:YuWenChaoTutor:ProfLiGangAbstractObjective：Tocomparetheclin

3、icaleffectsbetweenthesurgicaltechniquesofpercutaneousreductionbyleveragewithKirschnerpinsandtheopenreductionandinternalfixationwithplateandscrewsintreatingofcalcanealfracture.Methods：FromDecember2009toNovember2011,40patientswithintra-articularfracturesofthecalcaneusweretreatedintwodifferentwa

4、ys.20feetweretreatedwithKirschnerpins.Another20feetweretreatedwithplateandscrews.TheclassificationofthepostoperativefunctionwasbasedontheMarylandFootScore.Results：40caseswerefollowedupfor6-18months,anaverageof9months.Therewasnosignificantdifference(P>0.05)betweentherapeuticgroupandcontrolgrou

5、pintheperiodofknittingandpostoperativecomplicationsandtheBöhler'sdegree.AndthereductionofGissane'sdegreeoftherapeuticgroupwasobviouslybetterthanthecontrolgrouptreatedwithpercutaneousreductionbyleverageandinternalfixationKirschnerwire.AccordingtodifferencesoftheMarylandfootscore,thetotaleffect

6、iveratein2groupswas90%&50%.ForthepatientsofTypeIIIandIVfractures,plateandscrewsweremorebetterthanKirschnerpins.Conclusion：BoththesurgicaltechniquesofPercutaneousreductionbyleveragewithKirsehnerPinsandtheopenreductionandinternalfixationwithplateandscrewscanachievesatisfactoryresults.Accordingt

7、otypesoffracture、coverageofsofttissueandtheconditionofpatients，differentsurgicalmethodscanbeusedtotreatthefractureofcalcaneus.KeywordsCalcaneusfractureInternalfixationKirschnerpins目录引言..........................................................