[1]申建军 冯康虎 王久夏.外侧横弧形切口与L形切口在跟骨粉碎骨折 内固定治疗中的疗效比较[J].中国中医骨伤科杂志,2015,23(12):25-28.
　SHEN Jianjun FENG Kanghu WANG Jiuxia.Efficacy Comparison of Lateral Transverse Arc Incision and L Shaped Incision in Treating Comminuted Calcaneal Fracture[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2015,23(12):25-28.
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外侧横弧形切口与L形切口在跟骨粉碎骨折 内固定治疗中的疗效比较
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第23卷
期数:
2015年12期
页码:
25-28
栏目:
临床研究
出版日期:
2015-12-08

文章信息/Info

Title:
Efficacy Comparison of Lateral Transverse Arc Incision and L Shaped Incision in Treating Comminuted Calcaneal Fracture
文章编号:
1005-0205(2015)12-0025-04
作者:
申建军1 冯康虎1 王久夏1
1.甘肃省中医院创伤骨二科(兰州,730050)
Author(s):
SHEN Jianjun1 FENG Kanghu1 WANG Jiuxia1
1.Second Department of Trauma Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China.
关键词:
外侧横弧形切口;  L形切口;  跟骨骨折;  切口并发症
Keywords:
lateral transverse arc incision;  Lshaped incision;  calcaneal fractures;  wound complications
分类号:
R683.42
文献标志码:
A
摘要:
目的:比较外侧横弧形切口和L形切口两种手术入路在粉碎性跟骨骨折内固定术后的临床疗效。方法:回顾性分析2008年1月至2013年1月分别采用外侧横弧形切口与L形切口治疗并获随访的236例跟骨粉碎性骨折患者。按手术入路将患者分为两组,外侧横弧形切口组(A组)117例(120足):男97例,女20例; 平均年龄(39.84±7.65)岁; SandersⅡ型63足,Ⅲ型38足,Ⅳ型19足; 伤后至手术时间平均为(7.97±2.03)d.L形切口组(B组)119例(121足):男99例,女20例; 平均年龄(40.48±7.03)岁; SandersⅡ型66足,Ⅲ型37足,Ⅳ型18足; 伤后至手术时间平均为(8.34±2.17)d.两组患者在年龄、性别、Sanders分型等方面差异无统计学意义。观察比较两组患者:1)术中手术持续时间、失血量、切口长度、植骨例数,2)术后切口愈合情况,进行对比分析。结果:横弧形切口组的一期、二期愈合率分别为94.17%和5.83%,均显著高于L形组(P<0.05)。横弧形切口组伤口愈合时间(16.8±3.2)d及术后切口感染并发率(4.1%),均显著低于L形组(P<0.05)。两组患者AOFAS踝与后足评分差异无统计学意义(P>0.05)。结论:外侧横弧形切口与 L形切口治疗跟骨骨折疗效相当,但外侧横弧形切口相对较小、创伤小,术后切口愈合较快,切口并发症发生率较低。
Abstract:
Objective: To compare the clinical efficacy of lateral transverse arc incision and L shaped incision in treatment of comminuted calcaneal fracture.Methods: From January 2008 to January 2013,a retrospective analysis of 236 cases of calcaneal fractures treated with lateral transverse arc incision and L shaped incision was performed.They were divided into the lateral transverse arc incision group(group A )and the L shaped incision group(group B)according to the approach.Group A 117 cases(120 feet), 97 males and 20 females, mean age of(39.84±7.65)years old.SandersⅡ type 63 feet, Ⅲtype 38-feet, Ⅳ type 19 feet, the average time from injury to surgery was(7.97±2.03)days.Group B 119 cases(121 feet), male 99 cases, 20 females, mean age of(40.48±7.03)years old.Sanders Ⅱtype 66 feet, type Ⅲ 37 feet, type Ⅳ 18 feet, the average time from injury to surgery was(8.34±2.17)days.The two groups have no significant differences in age, sex, sanders type and so on.The surgery duration, blood loss, incision length, the number of graft cases and the postoperative incision healing time between the two groups were compared and analyzed.Results: The phase I and II healing rates in group A were 94.17%,5.83% respectively, which were significantly higher than those in group B(P<0.05).In group A, the wound healing time was(16.8±3.2)days and postoperative incision infection rate was 4.1% which were significantly lower than those in group B(P<0.05).There is no significant difference between the two groups in AOFAS ankle-hindfoot score(P>0.05).Conclusion: Lateral transverse arc incision and L shaped incision internal fixation has similar efficacy in treatment of comminuted calcaneal fracture.But the lateral transverse arc incision is relatively small, less trauma, faster wound healing, and the complications incidence of incision is lower.

参考文献/References:

[1] 危杰,刘璠,吴新宝,等译.骨折治疗的AO原则[M].2版.上海:上海科技出版社,2010:667.
[2] Kline AJ,Anderson RB,Davis WH,et al.Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures[J].Foot Ankle Int,2013,34(6):773-780.
[3] 中华人民共和国中医药行业标准.中医病症诊断疗效标准[M].北京:中国医药科技出版社,2012:169-170.
[4] 王亦璁.骨与关节损伤[M].3版.北京:人民卫生出版社,2001:1139-1140.
[5] 王淼,李公,潘恒,等.软组织评估及干预策略对预防跟骨骨折术后伤口并发症的临床意义[J].中华创伤骨科杂志,2012,14(8):659-663.
[6] 王瑞良,张媛,李森,等.跟骨骨折切开复位内固定术后皮缘坏死原因分析与对策[J].中国骨与关节损伤杂志,2011,26(2):169-170.
[7] 夏欣,江岳武.51例跟骨骨折内固定术后外侧切口皮缘愈合的病例分析[J].浙江创伤外科,2013,18(6):886-887.
[8] Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clincical rating sys-tems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[9] Hua Y,Chen S,Li Y,et al.Combination of modified brostrom procedure with ankie arthroscopy for chronic ankle instability accompanied by intraartcuiar symptoms[J].Arthroscopy,2010,26(4):524-528.
[10] Benirschke SK,Sangeorzan BJ.Extensive in traarticular fractures of the foot surgical management of calcaneal fractures[J].Clinical Orthopaedics and Related Research,1993,292:128-134.
[11] 郝东升,陈晨,王东,等.跟骨骨折外侧延长L形切口并发症非手术相关危险因素分析[J].中国修复重建外科杂志,2013,27(1):30-35.
[12] 冉党红,祝先锋,刘玉春,等.微创八字形切口钢板内固定治疗跟骨骨折[J].中国骨与关节损伤杂志,2014,29(12):1296-1297.
[13] Schepers T.The sinus tarsi approach in displaced intra-articular calcaneal fractures:a systematic review[J].Int Orthop,2011,35(5):697-703.
[14] 王震.小切口与“L”型切口治疗跟骨骨折疗效及并发症的对比研究[J].中国矫形外科杂志,2013,21(14):1402-1405.
[15] 夏胜利,王秀会,陆耀刚,等.经跗骨窦切口插入钢板与经外侧L形切口钢板内固定治疗跟骨骨折临床疗效的比较[J].中国骨与关节损伤杂志,2012,27(8):701-704.
[16] 朱学敏,唐三元,杨辉.跟骨骨折的微创治疗现状[J].生物骨科材料与临床研究,2014,11(1):31-34.
[17] 高士濂.实用解剖图谱(下肢分册)[M].上海:上海科技出版社,2012:267-269.
[18] 王满宜.移位关节内跟骨骨折的治疗[J].中国骨伤,2013,26(17):885-888.
[19] 洪勇,万胜,蒋州,等.跟骨骨折术后切口皮肤坏死的原因及预防措施[J].中国骨与关节损伤杂志,2014,29(2); 199-200.
[20] Wu Z,Su Y,Chen W,et al.Functional outcome of displaced intra-articular calcaneal fractures:a comparison between open reduction/internal fixation and a minimally invasive approach featured an anatomical plate and compression bolts[J].J Trauma Acute Care Surg,2012,73(3): 743-751.
[21] 陶忠生,于宝占,王明刚,等.宽窄交替减张缝合在跟骨骨折术后切口愈合中的作用[J].临床骨科杂志,2014,17(2): 239.

备注/Memo

备注/Memo:
收稿日期:2014-12-04
更新日期/Last Update: 2015-12-15