| 软组织Ⅲ度肿胀SandersⅣ型跟骨骨折的分期手术治疗 |
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投稿时间：2021-04-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 严志强 |
YAN Zhi-qiang |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
yyhdoc@163.com |
| 解绪红 |
XIE Xu-hong |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
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| 杨康胜 |
YANG Kang-sheng |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
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| 刘强 |
LIU Qiang |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
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| 李贝 |
LI Bei |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
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| 肖军 |
XIAO Jun |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
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| 区广鹏 |
OU Guang-peng |
广东医科大学附属佛山高明医院骨一科, 广东 佛山 528500 |
The First Department of Bone, Foshan Gaoming Hospital Affiliated to Guangdong Medical University, Foshan 528500, Guangdong, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第8期，第773-779页 |
| DOI：10.12200/j.issn.1003-0034.2021.08.016 |
| 基金项目:佛山市卫生和健康局医学科研课题（编号：20190435） |
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中文摘要:
目的：比较分期手术治疗软组织Ⅲ度肿胀Sanders Ⅳ型跟骨骨折的临床疗效。
方法：回顾分析2017年6月至2020年5月收治的76例软组织Ⅲ度肿胀Sanders Ⅳ型跟骨闭合骨折患者的临床资料，其中男54例，女22例，年龄25~50（38.16±10.24）岁。根据治疗方法不同分为观察组和对照组。观察组24例，男17例，女7例；年龄25~50（36.12±9.56）岁；采用Ⅰ期闭合撬拨牵引复位克氏针固定，Ⅱ期切开复位钛板内固定治疗。对照组52例，男37例，女15例；年龄25~50（38.32±10.67）岁；待皮纹征出现后行切开复位钛板内固定。比较两组患者肿胀消退时间、住院天数、术后切口并发症发生率，通过X线测量术前和术后6个月的Böhler角、Gissane角及跟骨内翻角，并采用美国足踝外科学会（American Orthopedic Foot and Ankle Society，AOFAS）踝-后足评分评价临床疗效。
结果：76例患者均获得随访，时间8~12（9.52±2.01）个月。两组患者肿胀消退时间、住院天数比较差异有统计学意义（P<0.05）。两组术后6个月Böhler角、Gissane角及跟骨内翻角组间比较差异有统计学意义（P<0.05），且两组术前与术后6个月比较差异均有统计学意义（P<0.05）。观察组术后6个月AOFAS评分（71.76±9.84）分与对照组（57.23±10.76）分比较差异有统计学意义（P<0.05）。观察组优良率显著高于对照组（P<0.05）。
结论：与皮纹征出现后行切开复位钛板内固定比较，采用分期手术治疗软组织Ⅲ度肿胀的Sanders Ⅳ型跟骨骨折，未增加软组织并发症风险，可明显缩短患者肿胀消退时间和住院天数，提高骨折复位质量，改善患者近期功能，减轻疼痛。 |
| 【关键词】跟骨骨折 分期手术 肿胀 手术后并发症 |
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| Staged surgery of Sanders type Ⅳ calcaneal fractures with soft tissue three-degree swelling |
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ABSTRACT
Objective: To compare the clinical efficacy of staged surgery on Sanders Ⅳ calcaneal fractures with soft tissue Ⅲ swelling.
Methods: The clinical data of 76 patients with Sanders type Ⅳ closed calcaneal fracture with soft tissue three-degree swelling treated from June 2017 to May 2020 was retrospectively analyzed,including 54 males and 22 females,aged from 25 to 50 (38.16±10.24) years. The patients were divided into observation group and control group according to different treatment methods. Twenty-four patients in the observation group were treated by staged surgery stageⅠclosed prying traction reduction and Kirschner wire fixation,stageⅡopen reduction and internal fixation with titanium plate,including 17 males and 7 females,aged from 25 to 50 (36.12±9.56) years. There were 52 patients in the control group,including 37 males and 15 females,aged from 25 to 50 (38.32±10.67) years,these patients were treated with open reduction and internal fixation with titanium plate after the dermatoglyphic signs appeared. The swelling subsidence time,the length of hospitalization days,and the incidence of postoperative incision complications were compared between two groups. The Böhler angle,Gissane angle,and calcaneal varus angle were measured by X-ray before and 6 months after operation. American Orthopedic Foot and Ankle Society(AOFAS) about the ankle-hindfoot score was used to evaluate the clinical efficacy.
Results: All 76 patients were followed up for 8 to 12 (9.52±2.01) months. The swelling subsidence time and hospitalization days in observation group were (12.12±3.24) d and (24.53±6.44) d,respectively,which in control group were(15.16±4.16) d and (29.46±9.61) d,with statistical difference between two groups(P<0.05). Postoperative 6 months,Böhler angle,Gissane angle and calcaneal varus angle were (31.33±10.15)°,(145.34±8.04) ° and (10.31±3.23) ° in observation group,while those in control group were (20.24±8.23) °,(165.28±10.29) ånd (21.24±5.27) °,with statistical difference between two groups (P<0.05). And there was significant difference in all patients between before and 6 months after operation (P<0.05). The AOFAS score of the observation group and control group were 71.76±9.84 and 57.23±10.76 at 6 months after operation,with significant different between two groups (P<0.05). The excellent rate of observation group was significantly higher than that of control group(P<0.05).
Conclusion: Compared with open reduction and internal fixation with titanium plate after the appearance of dermatoglyphic signs,staged surgery for Sanders type Ⅳ calcaneal fractures with soft tissue three-swelling does not increase the risk of soft tissue complications,and can significantly shorten the patient's swelling subsidence time and hospitalization days,improve the quality of fracture reduction and short-term function,and relieve pain. |
| KEY WORDS Calcaneal fracture Staged operation Swelling Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 严志强,解绪红,杨康胜,刘强,李贝,肖军,区广鹏.软组织Ⅲ度肿胀SandersⅣ型跟骨骨折的分期手术治疗[J].中国骨伤,2021,34(8):773~779 |
| 英文格式: | YAN Zhi-qiang,XIE Xu-hong,YANG Kang-sheng,LIU Qiang,LI Bei,XIAO Jun,OU Guang-peng.Staged surgery of Sanders type Ⅳ calcaneal fractures with soft tissue three-degree swelling[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(8):773~779 |
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