朱永展 1李逸群 1吴峰 1张宏宁 1温建强 1包杭生1
作者信息
- 1. 佛山市中医院骨科中心,广东佛山528000
- 折叠
摘要
Abstract
Objective:To compare therapeutic effects between Kirschner wire fixation after early debridement(Kirschner wire group) and staged plate fixation (plate group) in the treatment of open calcaneal fractures. Methods: From January 2001 to May 2008,55 patients (58 feel) with open calcaneal fractures were reviewed,the mean age was 36.8 years(ranged, 19 to 65 years) and the average visit time was 3 hours (ranged,30 min to 7 h). All the patients were divided into two groups:Kirschner wire group and plate group. There were 20 males(20 feet) and 9 females(9 feet) in Kirschner wire group,in which 15 feet were type 1,13 feet were type Ⅱ , 1 foot was type Ⅲ A according to Gustilo classification and 9 feet were type Ⅱ ,18 feet were type Ⅲ ,2 feet were type Ⅳ according to Sanders classification. The patients in Kirschner wire group were treated with early de-bridement,fracture reduction and Kirschner wire fixation,and the soft tissue defects were covered with VSD temporarily,and then were enveloped by skin or flap grafts at the second stage. There were 18 males (19 feet) and 8 females (10 feet) in the plate group, in which 13 feet were type 1,14 feet were type Ⅱ , 2 feet were type Ⅲ A according to Gustilo classification and 11 feet were type Ⅱ , 15 feet were type Ⅲ , 3 feet were type Ⅳ according to Sanders classification. The patients in the plate group were treated with early debridement, and plate internal fixation with were performed when the wound became stabilization. Results : Twenty-three feet (15 patients) in the Kirschner wire group and 22 feet (13 patients) in the plate group were followed, the duration ranged from 10 to 36 months,with an average of 24 months. Compared with preoperative ones,the heel height, width, Bohler angle and Gissane angle of calcaneal got improvements. According to AOFAS ankle- foot evaluation system, 11 feet got an excellent result,8 good in the Kirschner wire group;2 feet had wound local skin necrosis and cured by dressing; 1 foot had a large area of skin necrosis and deep infection; 1 foot had chronic osteomyelitis. All above 4 feet underwent arthrode-sis later. As comparison, 7 feet got an excellent result, 4 good in the plate group; 2 patients had mild complications of wounds; 1 patient had chronic osteomyelitis after early debridement; 10 patients had wound complications after internal fixation,including 7 patients with skin necrosis,superficial infection in 3 patients. There were statistical significant in radiological indicators and AOFAS ankle-foot scores between two groups. But there were no significant differences in early postoperative complications between the two groups. Conclusion : Early debridement and Kirschner wire fixation for the treatment of open calcaneal fractures has fewer early complications,which is a simple,safe and effective method.关键词
跟骨/骨折/骨折固定术,内/病例对照研究Key words
Calcaneus/Fractures/Fracture fixation, internal/Case-control studies
