Comparison of therapeutic effects of implant internal fixation for the treatment of Sanders Ⅱ calcaneal fractures after poking and open reduction

doi:10.3969/j.issn.2095-4344.2013.26.023

Abstract

Abstract:

BACKGROUND: Although, implant fixation is effective for many patients with calcaneal fractures, there is no consensus on the classification and treatment of calcaneal fractures as well as the choice of implants internal fixation.
OBJECTIVE: To compare the effect of poking reduction and open reduction internal fixation for the treatment of Sanders Ⅱ calcaneal fractures.
METHODS: The clinical data of the 56 patients with Sanders Ⅱ calcaneal fractures who treated in the Second Department of Orthopedics, Foshan Gaoming District People's Hospital from May 2010 to October 2012 were retrospectively analyzed. The age of the patients was 15-61 years. There were 27 cases treated with poking reduction fixation, and 29 cases were treated with open reduction internal fixation.
RESULTS AND CONCLUSION: All the patients were followed-up for 12-24 months, average 16.5 months. The postoperative X-ray film showed talar articular surface of calcaneus was recovered to normal basically. In the poking reduction fixation group, the Bohler angle was recovered from preoperative (17.88±2.06)° to postoperative (30.60±2.89)°; in the open reduction internal fixation group, the Bohler angle was recovered from preoperative (17.55±2.46)° to postoperative (31.69±2.29)°, and there was no significant difference in Bohler angle between two groups (P > 0.05). Evaluation of the postoperative function according to the Maryland foot score showed that in the poking reduction fixation group, there were 14 cases of excellent, six cases of good, five cases of average and two cases of poor, the excellent and good rate was 74.0%; in the open reduction internal fixation group, there were 11 cases of excellent, 13 cases of good, four cases of average and one case of poor, the excellent and good rate was 82.7%. There was no significant difference in the excellent and good rate between two groups (P > 0.05). Both poking reduction fixation and open reduction internal fixation are effective for the treatment of calcaneal fractures.

Key words: bone and joint implants, calcaneal fractures, internal fixation, open reduction, Gissane’s angle, Bohler’s angle, morphology, fracture displacement, surgical indications, preoperative evaluation, fracture complications

CLC Number:

R318

Xiong Hao1, Liu Wei1, Lin Wei-wen1, Xia Xiong-chao, Li Bei, Ou Cai-qiong, Lai Mao-song, Huang Rui-liang, Aihemaitijiang•Yusufu. Comparison of therapeutic effects of implant internal fixation for the treatment of Sanders Ⅱ calcaneal fractures after poking and open reduction[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.26.023.

Figures/Tables 4

2.5 并发症及不良反应所有被随访患者无一例发生明显的骨折再移位并发症，撬拨复位过早负重，出现轻微跛行有1例；切开复位钛板内固定组有2例出现伤口不愈合，皮肤边缘坏死，钛板外露，在愈合早期行钛板取出后有效治愈。经统计两组优良率差异无显著性意义(P > 0.05)。 2.6 与相关研究结果的比较 2.6.1 相关研究资料的获取检索CNKI数据库和SCI数据库的方法获取相关研究文献[12-13]。检索时间范围1990至2012年，检索词为“跟骨骨折(calcaneal fractures)；内固定(internal fixation)；切开复位(open reduction)；撬拨复位(poking reduction)；Gissane’s角(gissane’ s angle)；Bohler’s角(Bohler’s angle)；形态学(morphology)；骨折并发症(fracture complications)”，检索出相关研究文献46篇，其中CNKI数据库文献27篇，学术期刊13篇，学位论文6篇，会议论文8篇。SCI数据库文献19篇，学术期刊10篇，学位论文5篇，会议论文4篇。按设定的主题要求，纳入研究的文献共18篇[14-31]。 2.6.2 入选标准 ①研究的主题包括不同内固定方法在跟骨骨折中的意义、选择不同内固定治疗方案的影响因素、不同内固定方法治疗跟骨骨折的并发症等。检索的文献中排除与研究主题无关的文献18篇。②研究所撰写的文章类型包括原著、实验分析及病例分析等。检索文献中排除综述类文章4篇。③文献内容筛选如下，检索的文献中比较撬拨复位闭合穿针和切开复位钢板固定治疗跟骨骨折的效果的研究文献共3篇，3篇文献为同一实验项目，且为同一组实验人员进行的研究，定为重复研究文献，选取其中1篇进行深入分析。同样对年龄、骨折的类型等影响内固定治疗方案选择因素研究的2篇文献也为重复文献，选取其中1篇进行深入分析。在不同内固定方法治疗跟骨骨折的并发症研究中，同样检索出重复的3篇研究文献，选取其中1篇进行深入分析。 2.6.3 质量评估符合纳入标准的18篇研究中，分析了不同内固定方法在跟骨骨折中的意义[14-16]；并探讨了选择不同内固定治疗方案的影响因素[17-20]；分析了不同内固定方法治疗跟骨骨折的并发症[21-25]；探讨了撬拨复位闭合穿针和切开复位钢板固定治疗跟骨骨折的效果[26-31]。 2.6.4 不同植入物内固定治疗跟骨骨折的意义李灿杨等[14]为比较撬拨复位闭合穿针和切开复位钢板固定治疗跟骨骨折的效果。对80例跟骨骨折患者，在手法复位的基础上分别采用撬拨复位克氏针外固定(A组)和切开复位钢板内固定(B组)治疗。其中SandersⅡ型跟骨骨折两组不同内固定方法治疗前后的测量指标比较，见表7。"

References

[1] Barei DP,Bellabarba C,Sangeorzan BJ,et al.Fractures of the calcaneus.Orthop Clin North Am.2002;33(1):263-285.

[2] 俞光荣,燕晓宇.跟骨骨折治疗方法的选择[J].中华骨科杂志, 2006,26(2):134-141.

[3] 郑移兵,齐越峰.跟骨骨折治疗研究进展[J].中国骨伤,2012, 25(11): 962-966.

[4] 田士松,陈爱桂.切开复位内固定治疗移位关节内跟骨骨折[J].河北医药,2008,30(9):1453.

[5] Strømsøe K,Mørk E,Hem ES.Open reduction and internal fixation in 46 displaced intraarticular calcaneal fractures. Injury.1998;29(4):313-316.

[6] Melcher G,Degonda F,Leutenegger A,et al.Ten-year follow-up after operative treatment for intra-articular fractures of the calcaneus.J Trauma.1995;38(5):713-716.

[7] 梁军,胡滨成.跟骨的形态结构特点及其临床意义[J].中国临床解剖学杂志,2000,16(2):118-120.

[8] Sarrafian SK.Biomechanics of the subtalar joint complex.Clin Orthop Relat Res.1993;(290):17-26.

[9] Rammelt S,Barthel S,Biewener A,et al.Calcaneus fractures. Open reduction and internal fixation.Zentralbl Chir.2003; 126(8): 517-528.

[10] Gavlik JM,Rammelt S,Zwipp H.Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus fractures.Arch Orthop Trauma Surg.2002;122(8):424-428.

[11] Stehlík J,Stulík J.Combined method of treating dislocated fractures of the calcaneus.Acta Chir Orthop Traumatol Cech.2002;69(4):209-218.

[12] 中国知网.中国学术期刊总库[DB/OL].2013-02-10.https://www.cnki.net

[13] SCI数据库.Web of Sciencevia ISI Web of Knowledge[DB/OL]. 2013-02-10.http://ip-science.thomsonreuters.com/mjl

[14] 李灿杨,吴征杰,潘志雄.撬拨复位闭合穿针和切开复位钢板固治疗跟骨骨折的临床研究[J].中国中医骨伤科杂志,2013,21(2): 18-20.

[15] 韩杰,何燕飞,雷翔宇.经皮撬拨复位内固定治疗跟骨骨折[J].河南科技大学学报（医学版）,2010,28(2):116-117.

[16] 韩立新,李旭芬,李凤新.跟骨压缩性骨折切开复位与撬拨复位治疗比较[J].中华创伤骨科杂志,2004,6(6):701-703.

[17] Paley D,Hall H.Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors.J Bone Joint Surg Am.1993;75(3):342-354.

[18] Loucks C,Bohler's angle: correlation with outcome in displaced intra-articular calcaneal fractures.J Orthop Trauma.1999;13(8):554-558.

[19] Ramanujam CL,Wade J,Selbst B,et al.Recurrent acute compartment syndrome of the foot following a calcaneal fracture repair.Clin Podiatr Med Surg.2010;27(3):469-474.

[20] Harvey EJ,Grujic L,Early JS,et al.Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach.Foot Ankle Int.2001;22(11):868-873.

[21] Atesok K,Finkelstein J,Khoury A,et al.The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures.Injury.2007; 38(10): 1163-1169.

[22] Folk JW,Starr AJ,Early JS.Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures.J Orthop Trauma.1999;13(5):369-372.

[23] Richter M,Geerling J,Zech S,et al.Intraoperative three-dimensional imaging with a motorized mobile C-arm (SIREMOBIL ISO-C-3D) in foot and ankle trauma care: a preliminary report.J Orthop Trauma.2005;19(4):259-266.

[24] Sanders R.Displaced intra-articular fractures of the calcaneus.J Bone Joint Surg Am.2000;82(2):225-250.

[25] 郭宗信.跟骨骨折内固定手术并发症分析[J].交通医学,2006, 20(5):556-557.

[26] 魏金亮,邱波,汪喆,等.跟骨关节内骨折切开复位与撬拨复位治疗比较[J].临床外科杂志,2011,19(9):632-634.

[27] Potenza V,Caterini R,Farsetti P,et al.Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.Injury.2010;41(7):702-706.

[28] Rammelt S,Zwipp H.Calcaneus fractures: facts, controversies and recent developments.Injury.2004;35(5):443-461.

[29] 白正发,贺西京.撬拨复位治疗跟骨骨折中的手法技巧[J].中国社区医师,2007,19(6):75.

[30] 吴铁男,郭豪,郭宏钰,等.金针撬拨法治疗跟骨骨折100例[J].中国骨伤,2000,13(1):45.

[31] 彭光军,王荣华,衡德峰,等.跟骨骨折不同内固定方法治疗的比较研究[J].中国矫形外科杂志,2010,18(20):1686-1688.