范　淼　孔凡盛南京市高淳中医院骨科，江苏南京　211300

两种内固定术治疗跟骨骨折术后并发症的前瞻性研究

范淼孔凡盛
南京市高淳中医院骨科，江苏南京211300

目的探讨经皮撬拨空心螺钉内固定术的疗效。方法收集2012年2月～2014年12月跟骨骨折患者共78例，采用前瞻性对照研究方法，切开复位钢板内固定术为A组，经皮撬拨空心螺钉内固定术为B组，对比分析两组患者术后并发症情况及骨折愈合时间。结果随着骨折分型增加，两组患者术后并发症及骨折愈合时间随之增加。SandersⅡ、Ⅲ型中，B组患者切口感染、骨折延迟愈合、创伤性关节炎发生率明显降低，较A组差异有统计学意义（P＜0．05）。SandersⅣ型中，B组患者切口感染、创伤性关节炎发生率明显降低，较A组差异有统计学意义（P＜0．05）。B组患者骨折愈合时间明显缩短，较A组差异有统计学意义（P＜0．05）。结论经皮撬拨空心螺钉内固定术治疗跟骨骨折可明显减少术后并发症，缩短骨折愈合时间，且费用较低，值得推广。

跟骨骨折；术后并发症；经皮撬拨；切开复位

［Abstract］Objective To discuss the efficacy of percutaneous poking reduction and cannulated screw internal fixation. M ethods 78 patients with calcaneal fracture treated from February 2012 to December 2014 were selected in this prospective case-control study.Patients who were given open reduction and internal fixation with steel plate were divided into group A，and patientswith percutaneous poking reduction and cannulated screw internal fixation were divided into group B.The incidence rates of postoperative complications and time of fracture healing were compared and analyzed between two groups.Results Along with the increase of fracture classification，the incidence rate of postoperative complications and time of fracture healing also increased.In types of Sanders IIand III，the incidence rates of incision infection，delayed union of fracture，and traumatic arthritiswere significantly lower in group B than in group A（P＜0.05）. In type of Sanders IV，the incidence rates of incision infection and traumatic arthritiswere significantly lower in group B than in group A（P＜0.05）.The healing time of fracture was significantly shorter in group B than in group A（P＜0.05）. Conclusion Percutaneous poking reduction and cannulated screw internal fixation can significantly reduce the incidence rate of postoperative complications of calcaneal fracture，and shorten the healing time of fracture，with lower cost，thus isworthy to be promoted.

［Key words］Calcaneal fracture；Postoperative complications；Percutaneous poking；Open reduction

跟骨骨折是临床常见的下肢骨折，以中青年为主［1］，大多为关节内骨折，其复位程度直接影响远期疗效，若处置不当，关节面往往容易不平整从而导致多种并发症［2］。目前主流治疗方案为外侧“L”入路切开复位钢板内固定术［3］。然据报道，该术式的术后并发症高达30%以上［4］。临床工作中笔者亦发现该术式并发症主要集中在切口感染、骨折延迟愈合，创伤性关节炎等方面。我院骨伤科团队采用经皮撬拨空心螺钉内固定术有效减少术后并发症，缩短骨折愈合时间，取得满意疗效，现报道如下。……