Qi Yue-Feng, Zheng Yi-Bing, Wang Peng, Li Ye, Chen Wen-xue, Dong Yan-Xu, Jin Li-Kun, Wang Chen-Xi, Li Xu
Fengsheng Special Hospital of Orthopaedics and Traumatology, Beijing, China.
Zhongguo Gu Shang. 2013 Apr;26(4):291-6.
To explore the clinical effects and safty of manipulative reduction with percutaneous poking K-wire fixation for the treatment of the calcaneus fractures and analyze the indication of the minimal invasion.
From December 2008 to December 2011,135 closed calcaneal fractures cases were divided randomly into poking group and plate group, treated respectively by percutaneous poking reduction and operative reduction. In poking group, there were 69 cases (82 feet) including 60 males and 9 females, with an average age of (43.29+/-10.46) years ranging from 18 to 64 years; 30 cases of left, 26 cases of right and 13 cases of double; 54 feet of Essex-Lopresti classification tongue form, 28 feet of joint compression; 33 feet of Sanders type II ,49 of type III. In plate group, there were 66 cases (75 feet) including 58 males and 8 females,with an average age of (46.00+/-2.42) years ranging from 21 to 63 years; 31 cases of left, 26 cases of right and 9 cases of double; 48 feet of Essex-Lopresti classification tongue form, 27 feet of joint compression; 28 feet of Sanders type II, 47 of type III. According to Kerr scoring standard,clinical effects and complications were evaluated combining with Sanders and Essex-Lopresti classification.
All 135 cases were followed up after 24 weeks. Fractures were recoveried in 8 to 12 weeks (means 10.2 weeks). In poking group, there were 2 cases of infection, 5 cases of wire movement; in plate group,18 cases of wound local skin necrosis, 5 cases of calf intestines nerve injured; there were statistical significant (P<0.05). Postoperative evaluation of Sanders type II after 24 weeks, the proportion of excellent results was above 70%,and there were no significant differences on effects of tongue form and compressing form of calcaneus fractures with percutaneous poking and operative redution (P>0.05). In the caes of Sanders type III, there were no significant differences on effects of tongue form fractures with percutaneous poking and operative reduction (P>0.05). There were significant differences on effects and complications of compressing form fractures (P<0.01), operative reduction better than percutaneous poking. Pain, walking,Kerr scoring of tongue form fractures of Sanders II , III with poking reduction were better than compression fractures. In compression fractures of Sanders Ill, plate internal fixation was better than poking redution in working and walking function, there were significant difference (P<0.05).
For tongue form or compressing form of Sanders type II and tongue form of Sanders type III, manipulative reduction with percutaneous poking K-wire fixation has advantages of minimal invasion, minimized complications. Compressing form of Sanders type III fracture should be treated with operative redution.
探讨经皮撬拨克氏针内固定治疗跟骨骨折的临床疗效及安全性，分析微创治疗的适应证。
2008年12月至2011年12月，将135例闭合性跟骨骨折患者随机分为撬拨组和钢板组，分别采用经皮撬拨复位和切开复位治疗。撬拨组69例（82足），男60例，女9例，平均年龄（43.29±10.46）岁，年龄18～64岁；左侧30足，右侧26足，双侧13足；Essex-Lopresti分型舌形54足，关节压缩型28足；SandersⅡ型33足，Ⅲ型49足。钢板组66例（75足），男58例，女8例，平均年龄（46.00±2.42）岁，年龄21～63岁；左侧31足，右侧26足，双侧9足；Essex-Lopresti分型舌形48足，关节压缩型27足；SandersⅡ型28足，Ⅲ型47足。根据Kerr评分标准，结合Sanders和Essex-Lopresti分型评估临床疗效及并发症。
135例均随访24周。骨折均在8～12周愈合（平均10.2周）。撬拨组发生感染2例，克氏针松动5例；钢板组发生伤口局部皮肤坏死18例，腓肠神经损伤5例，差异有统计学意义（P<0.05）。术后24周SandersⅡ型评估，优良率均在70%以上，经皮撬拨与切开复位治疗跟骨骨折舌形和压缩型疗效差异无统计学意义（P>0.05）。SandersⅢ型中，经皮撬拨与切开复位治疗舌形骨折疗效差异无统计学意义（P>0.05）。压缩型骨折疗效及并发症差异有统计学意义（P<0.01），切开复位优于经皮撬拨。SandersⅡ、Ⅲ型舌形骨折撬拨复位后疼痛、行走、Kerr评分均优于压缩型骨折。SandersⅢ型压缩骨折中，钢板内固定在工作和行走功能方面优于撬拨复位，差异有统计学意义（P<0.05）。
对于SandersⅡ型舌形或压缩型及SandersⅢ型舌形跟骨骨折，经皮撬拨克氏针内固定具有微创、并发症少的优点。SandersⅢ型压缩骨折应采用切开复位治疗。
