解剖钢板和加压螺栓微创治疗跟骨关节内骨折的相关基础与临床研究

・论著・解剖钢板和加压螺栓微创治疗跟骨关节内骨折的相关基础与临床研究霍乐乐（福建中医药大学，福建 福州 ３５０１２２）摘要：目的探究解剖钢板与加压螺栓微创治疗跟骨关节内骨折的临床疗效。

方法选取本院2014年4月至2016年9月间收治的42例跟骨关节内骨折患者，分为实验组与对照组，每组各21例，分别采用解剖钢板与加压螺栓微创治疗及传统AO解剖钢板与螺钉治疗，观察两组治疗效果。

结果两组患者Bohler角恢复与AOFAS评分比较无统计学意义（P>0.05），实验组手术时间短于对照组，具有统计学意义（P<0.05）；实验组术后疼痛度低于对照组，深部感染少于对照组，具有统计学意义（P<0.05）。

结论跟骨关节内骨折采用解剖钢板加压螺栓微创治疗手术时间短，术后深度感染少、疼痛轻，安全、有效，值得采用与推广。

关键词：解剖钢板；加压螺栓；微创治疗；跟骨关节内骨折中图分类号：R322 文献标识码：A DOI：10.3969/j.issn.1671-3141.2016.88.008Related Basic and Clinical Study on Minimally Invasive Treatment of Intra-articular Calcaneal Fracture with Anatomical Plate and Compression BoltHUO Le-le(Fujian University of Traditional Chinese Medicine, Fuzhou,Fujian 350122)ABSTRACT：Objective to investigate clinical effect of minimally invasive treatment of intra-articular calcaneal fracture with anatomical plate and compression bolt. Methods choose 42 cases intra-articular calcaneal fracture patients treated in our hospital from April 2014 to September 2016, and divide them into experimental group and control group, 21 cases in each, who received minimally invasive treatment of anatomical plate and compression bolts and traditional treatment of AO anatomical plate and screw respectively, observe curative effect of two groups. Results comparison of recovery of Bohler angle and AOFAS scores of two groups showed no statistical significance(P>0.05), operation time of experimental group was shorter than control group with statistical significance (P<0.05);postoperative pain degree of was lower than control group, and deep infection was less than control group with statistical significance(P<0.05). Conclusion minimally invasive surgical treatment with anatomical plate and compression bolt is safe and effective for intra-articular calcaneal fracture, it has advantages of shorter operation time, less deep infection and pain, which is worthy of application and promotion.KEY WORDS：A natomical plate; C ompression bolt; minimally invasive treatment; Intra-articular calcaneal fracture0　引言跟骨关节内骨折是骨科常见骨折类型，随着手术发展以及影像学检查的进步，术前软组织处理取得了显著进展，应用手术治疗跟骨关节内骨折疗效得到广泛认同。

大量临床研究与报道显示，手术治疗比起保守治疗跟骨关节骨折有更显著疗效，可以使患肢更快恢复，使距下关节炎发生率降低。

研究选取本院２０１４年４月至２０１６年９月间收治的４２例跟骨关节内骨折患者，探究解剖钢板与加压螺栓微创治疗的效果，现总结报道如下。

1　资料与方法１．１　一般资料。

随机选取本院２０１４年４月至２０１６年９月间收治的４２例跟骨关节内骨折患者作为此次研究样本，其中，男２５例，女１７例，年龄３２￣５９岁，平均年龄（４５．５±２．５）岁，左侧损伤１７例，右侧损伤１０例，双侧损伤１５例，ＩＩ型跟骨关节内骨折１５例，ＩＩＩ型跟骨关节内骨折１８例，ＩＶ型跟骨关节内骨折９例。

将４２例患者分为两组，实验组与对照组各２１例，两组患者一般资料对比，包括年龄、性别、骨折分型等差异无统计学意义，Ｐ＞０．０５。

１．２　方法。

实验组采用解剖钢板加压螺栓微创手术治疗，取患者侧卧位，患肢朝上，在跟骨结节主骨块上置入两枚斯式针，在Ｃ型臂透视机下调至进针点，主要对针的方向与深度进行调整［１－２］。

挤压患者跟骨侧方，使患者跟骨宽度与高度恢复，对大体外形进行调整［３］。

在根骨外侧平行于跟腱处做长度为３．５ｃｍ左右的切口，使用骨膜分离器将骨膜剥离，确保　跟骨与下皮组织自然形成一条隧道，在隧道内将钢板插入，使用Ｃ型臂透视机对钢板位置进行调整，调整好后将加压螺栓置入，加压固定处理，缝合皮肤，包扎切口。

对照组采用ＡＯ解剖钢板与螺钉，手术过程同实验组。

１．３　评价指标。

对两组患者手术时间、术后并发症发生率、Ｂｏｈｌｅｒ角恢复情况。

对患者疼痛情况与功能情况进行评估，评估依据美国足与踝关节协会评分标准。

对患者进行１年随访，后进行固定移除术。

１．４　统计学处理。

本次研究使用ＳＰＳＳ　１５．０软件对计数资料进行统计分析，使用标准差（χ—±s）与（％）计量与计数，使用t检验计数资料，χ２检测统计结果，以Ｐ＜０．０５表示有统计学意义。

2　结果两组患者Ｂｏｈｌｅｒ角恢复与ＡＯＦＡＳ评分比较无统计学意义（P>０．０５），实验组手术时间短于对照组，具有统计学意义（P<０．０５）；实验组术后疼痛度低于对照组，深部感染少于对照组，具有统计学意义（P<０．０５），详见表１、２。

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