本文選題：微創(chuàng)撬撥復位 + 切開復位內(nèi)固定�。� 參考：《安徽中醫(yī)藥大學》2015年碩士論文

【摘要】：目的:本研究以跟骨骨折的發(fā)病機制、診治方法和并發(fā)癥等理論研究為基礎,通過比較微創(chuàng)撬撥復位空心釘內(nèi)固定結(jié)合接骨續(xù)筋口服液方法和切開復位鋼板內(nèi)固定結(jié)合接骨續(xù)筋口服液方法治療Sander II型和III型跟骨骨折的臨床療效,闡明微創(chuàng)撬撥復位空心釘內(nèi)固定配合接骨續(xù)筋口服液治療方法的優(yōu)勢,為其在臨床上推廣應用提供可靠依據(jù)。方法:本組研究共納入Sander II型和III型跟骨骨折病例40例,隨機分成兩組,即治療組和對照組各20例。其中治療組予以微創(chuàng)撬撥復位空心釘內(nèi)固定術(shù)治療;對照組予以切開復位鋼板螺釘內(nèi)固定術(shù)治療。在術(shù)后,兩組病例均給予院內(nèi)中藥制劑(接骨續(xù)筋口服液)內(nèi)服并配合功能鍛煉。術(shù)后對患者行6~12個月的隨訪,通過對兩者在手術(shù)時間、手術(shù)出血量、骨折愈合時間、術(shù)后并發(fā)癥發(fā)生率以及手術(shù)前后功能恢復情況、影像學相關(guān)解剖角度復位情況等方面的對比,并將評估數(shù)據(jù)進行統(tǒng)計學分析處理,以此比較兩種手術(shù)方法在治療Sander II型和III型跟骨骨折的優(yōu)劣性。結(jié)果:兩種方法在臨床上治療Sander II型和III型跟骨骨折上均獲得滿意的治療效果。其中在功能評分方面,治療組和對照組相當(P0.05);在影像學解剖復位方面,治療組和對照組沒有明顯差異(P0.05);但是,與對照組相比,治療組在手術(shù)耗費時間、術(shù)中出血量、骨折愈合時間以及手術(shù)并發(fā)癥發(fā)生率等方面具有明顯的優(yōu)勢(P0.01)。結(jié)論:兩種方法治療Sander II型和III型跟骨骨折的臨床療效相當,均為有效可靠的治療方法。但是,較切開復位鋼板螺釘內(nèi)固定術(shù),微創(chuàng)撬撥復位空心釘內(nèi)固定術(shù)具有手術(shù)操作相對簡單、手術(shù)所需時間少、術(shù)中出血量少、愈合快、術(shù)后并發(fā)癥少等優(yōu)點;同時,由于較小的手術(shù)創(chuàng)傷相對減輕了患者的痛苦,使患者易于接受。因此,微創(chuàng)撬撥復位空心釘內(nèi)固定術(shù)應在嚴格把握適應癥的前提下,作為一種治療跟骨骨折較好的方法在臨床上推廣應用。
[Abstract]:Objective: this study is based on the theoretical study of the pathogenesis, diagnosis and treatment of calcaneal fracture, and complications. To compare the clinical effects of minimally invasive prying reduction with hollow nail fixation combined with continuous bone joint oral liquid and open reduction plate fixation combined with bone graft oral liquid in the treatment of Sander type II and type III calcaneal fractures, and compared the clinical efficacy of the two methods in the treatment of Sander type II and type III calcaneal fractures. To expound the advantages of minimally invasive prying reduction and hollow nail internal fixation combined with the oral liquid of bone joint and continue to strengthen the bone, and to provide reliable basis for its clinical application. Methods: 40 cases of Sander type II and III calcaneal fractures were randomly divided into two groups: treatment group (n = 20) and control group (n = 20). The treatment group was treated with minimally invasive prying reduction and hollow nail fixation, while the control group was treated with open reduction plate screw fixation. After operation, the two groups were given traditional Chinese medicine (Jiegxujin oral liquid) and combined with functional exercise. The patients were followed up for 612 months after operation. The time of operation, the amount of bleeding, the time of fracture healing, the incidence of postoperative complications and the recovery of function before and after operation were analyzed. The anatomic angle reduction was compared and the evaluation data were analyzed statistically to compare the advantages and disadvantages of the two surgical methods in the treatment of Sander type II and III calcaneal fractures. Results: the two methods obtained satisfactory results in the treatment of Sander type II and III calcaneal fractures. In the functional score, the treatment group and the control group were quite P0.05, while in the imaging anatomical reduction, there was no significant difference between the treatment group and the control group. However, compared with the control group, the treatment group took time and lost blood during the operation. The fracture healing time and the incidence rate of operative complications have obvious advantages (P 0.01). Conclusion: the two methods are effective and reliable in the treatment of Sander type II and III calcaneal fractures. However, compared with open reduction, plate and screw internal fixation, minimally invasive prying reduction and hollow nail internal fixation has the advantages of relatively simple operation, less operation time, less intraoperative bleeding, faster healing, less postoperative complications, and so on. Because of minor surgical trauma, the patient's pain is relatively reduced and the patient is easily accepted. Therefore, minimally invasive prying reduction and hollow nail fixation should be applied as a better method for the treatment of calcaneal fracture under strict indication.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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