本文選題：跟骨骨折 + 鎖定鋼板��； 參考：《江蘇大學(xué)》2016年碩士論文

【摘要】：[背景]近年來,跟骨骨折尤其是涉及移位的關(guān)節(jié)內(nèi)跟骨骨折損傷機制復(fù)雜,其在治療方式上一向備受爭議,外側(cè)“L”型延長切口切開復(fù)位內(nèi)固定術(shù)已成為外科手術(shù)治療跟骨骨折的金標準,但此切口術(shù)中軟組織剝離多,加之跟骨外側(cè)局部軟組織菲薄、血運較差,切口皮緣壞死不愈合及軟組織感染發(fā)生率較高。隨著微創(chuàng)理念的不斷深入,越來越多的外科醫(yī)師采用微創(chuàng)手術(shù)治療跟骨骨折,因其可以最大程度的減輕軟組織損傷,保護血供,降低切口并發(fā)癥發(fā)生率。微創(chuàng)手術(shù)術(shù)式眾多,各類微創(chuàng)手術(shù)治療跟骨骨折取得了良好的臨床療效,但對于傳統(tǒng)手法復(fù)位結(jié)合皮膚外放置鎖定鋼板治療SandersⅡ、Ⅲ型跟骨骨折的臨床研究尚不夠深入,其手術(shù)安全性、臨床療效及術(shù)后近遠期并發(fā)癥值得進一步探討。[目的]探討傳統(tǒng)手法復(fù)位結(jié)合鎖定鋼板外置治療Sanders Ⅱ、Ⅲ型跟骨骨折的手術(shù)安全性及效果,并分析其術(shù)后近遠期并發(fā)癥的發(fā)生原因及其應(yīng)對策略。[方法](1)手術(shù)安全性及效果分析:選取2012年1月1日-2014年12月31日符合選擇標準的52例Sanders Ⅱ、Ⅲ型跟骨骨折患者作為研究對象,隨機分為兩組。研究組25例以傳統(tǒng)手法復(fù)位結(jié)合皮膚外放置鎖定鋼板外固定進行治療,對照組27例采用傳統(tǒng)的切開復(fù)位內(nèi)固定進行治療。組間比較患者性別、年齡、致傷原因等一般資料無顯著統(tǒng)計學(xué)差異(P0.05)的基礎(chǔ)上,比較兩組手術(shù)時間、術(shù)中出血量、術(shù)中X線暴露時間、術(shù)后軟組織感染評價手術(shù)安全性,比較兩組術(shù)后跟骨長度、寬度、高度變化情況,Bohler角和Gissane角改善程度,骨折愈合時間及術(shù)后1年足功能評分評價手術(shù)效果。(2)術(shù)后近遠期并發(fā)癥分析:對上述采取傳統(tǒng)手法復(fù)位皮外放置鎖定鋼板固定術(shù)式治療的研究組25例跟骨骨折患者進行回顧性分析,隨訪18-36個月,平均22.4月,對術(shù)后出現(xiàn)釘?shù)婪磻?yīng)、神經(jīng)損傷、腓骨長短肌腱受累、足部慢性疼痛等相關(guān)并發(fā)癥進行分析,末次隨訪采用Maryland足功能評分評價遠期療效。[結(jié)果](1)與對照組相比,研究組手術(shù)時間短、術(shù)中出血量少、軟組織感染率低,差異有統(tǒng)計學(xué)意義(P0.05),術(shù)中X線暴露時間無明顯差異(P0.05);兩種術(shù)式術(shù)前后均能明顯改善跟骨的長度、高度、寬度、Bohler角和Gissane角(P0.05),改善程度無明顯差異(P0.05),組間比較上述指標無明顯差異(P0.05);兩組均未觀察到骨折延遲愈合或不愈合的病例,骨折愈合時間相同(P0.05)。術(shù)后1年,兩組足功能均恢復(fù)滿意,Maryland評分優(yōu)良率無明顯差異(P0.05)。(2)研究組25例均獲隨訪,無失訪病例,最終納入研究25例(25足),術(shù)后隨訪18-36個月,平均22.4月。末次隨訪Maryland足功能評分優(yōu)22例,良2例,中1例,差0例,Maryland總分平均分為94.5分,優(yōu)良率96%。術(shù)后出現(xiàn)釘?shù)婪磻?yīng)3例,神經(jīng)損傷2例,腓骨長短肌腱損傷1例,足部慢性疼痛1例。[結(jié)論](1)傳統(tǒng)手法復(fù)位結(jié)合鎖定鋼板外置治療Sanders Ⅱ、Ⅲ型跟骨骨折手術(shù)安全性高,能夠取得與傳統(tǒng)術(shù)式相同的臨床效果,且手術(shù)創(chuàng)傷更小、手術(shù)時間更短、術(shù)后軟組織感染率低,具有一定的微創(chuàng)優(yōu)勢。(2)經(jīng)皮外置鎖定鋼板治療Sanders Ⅱ、Ⅲ型跟骨骨折是一種有效的微創(chuàng)手術(shù)方式,但術(shù)后也存在一定的并發(fā)癥,術(shù)前熟悉跟骨局部解剖、掌握好手術(shù)技巧以及合理的圍手術(shù)期處理可以減少相關(guān)并發(fā)癥發(fā)生,此外,并發(fā)癥一旦發(fā)生需積極采取措施對癥處理。
[Abstract]:[background] in recent years, the mechanism of calcaneal fracture, especially the transposition of intra-articular calcaneal fracture, is very complicated. It has always been controversial in the way of treatment. Lateral "L" type lengthening incision and internal fixation has become the gold standard for surgical treatment of calcaneal fracture. However, the soft tissue dissection and the lateral calcaneus of the calcaneus are more in this incision. The soft tissue is thin, the blood transport is poor, the necrosis of the incision skin necrosis and the incidence of soft tissue infection are high. With the continuous deepening of the concept of minimally invasive, more and more surgeons use minimally invasive surgery for the treatment of calcaneus fracture, because it can minimize the injury of soft tissue, protect blood supply and reduce the incidence of incision complications. Minimally invasive surgical operation Many kinds of minimally invasive surgery for the treatment of calcaneus fracture have achieved good clinical effect, but the clinical study of traditional manipulative reduction combined with locking plate outside the skin in the treatment of Sanders II and type III calcaneus fracture is not deep enough. The safety, clinical efficacy and postoperative complications of the treatment of calcaneal fractures deserve further discussion. The operation safety and effect of Sanders II, type III calcaneal fracture treated with the combination of manual reduction and locking plate, and analysis of the causes and coping strategies of the near and long term complications after the operation. [method] (1) the operation safety and effect analysis: 52 cases of Sanders II, type III, which were in accordance with the selection criteria in December 31st January 1, 2012, were selected. The patients with calcaneal fracture were randomly divided into two groups. 25 cases in the study group were treated by traditional manipulative reduction and external fixation with locking plate outside the skin, and 27 cases in the control group were treated with traditional open reduction and internal fixation. There was no significant statistical difference between the group and the general data of the patients' sex, age, and cause of injury (P0.05) On the basis of the two groups, the operation time, the amount of intraoperative bleeding, the exposure time of X-ray, the postoperative soft tissue infection evaluation of the operation safety, compared the length of the calcaneus, the width, the height, the improvement of the Bohler angle and Gissane angle after operation, the time of fracture healing and the 1 year foot function score after the operation were compared between the two groups. (2) close to long term after operation, and Analysis of hair symptoms: a retrospective analysis of 25 cases of calcaneal fracture with traditional manipulation and locking plate fixation. A follow-up of 18-36 months was followed up for an average of 22.4 months. The postoperative complications such as nail tract reaction, nerve injury, peroneal tendon involvement, and chronic pain in the foot were analyzed, and the last time was analyzed. Maryland foot function score was used to evaluate the long-term effect. [results] (1) compared with the control group, the operation time of the study group was shorter, the amount of bleeding in the operation was less, the infection rate of soft tissue was low, the difference was statistically significant (P0.05), there was no significant difference in the exposure time during the operation (P0.05), and the length, height, width, Boh of the calcaneus could be obviously improved before and after the operation. Ler angle and Gissane angle (P0.05) had no significant difference (P0.05). There was no significant difference between the two groups (P0.05). No cases of delayed union or nonunion of fracture were observed in the two groups, and the time of fracture healing was the same (P0.05). The two groups of foot function recovered satisfactorily in the 1 year after operation, and there was no significant difference in the good rate of Maryland score (P0.05). (2) study on the good rate of Maryland score. All 25 cases were followed up, with no missing cases, and 25 cases (25 feet) were included in the study. The follow-up was 18-36 months, mean 22.4 months. The last follow-up Maryland foot function score was excellent 22 cases, good 2 cases, 1 cases and 0 cases, the average score of Maryland was 94.5 points, excellent rate 96%. postoperative nailing reaction occurred in 3 cases, nerve injury 2 cases, fibula tendon injury 1 cases, foot, foot. 1 cases of chronic pain. [Conclusion] (1) the traditional manipulative reduction combined with locking plate for Sanders II and type III calcaneus fracture has high safety. It can obtain the same clinical effect as the traditional method, and the surgical trauma is smaller, the operation time is shorter, the infection rate of soft tissue is low after operation, and it has a certain minimally invasive advantage. (2) external locking steel for the percutaneous locking steel. Plate treatment of Sanders II and type III calcaneus fracture is an effective minimally invasive operation, but there are some complications after operation. Familiar with the local anatomy of the calcaneus, mastering the surgical skills and reasonable perioperative management can reduce the incidence of related complications. In addition, when the onset of the disease needs to be taken active measures to treat the disease.

【學(xué)位授予單位】：江蘇大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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