解剖型钢板与锁定钢板治疗有移位的跟骨骨折的效果

Effect of anatomical plate and locking plate for displaced calcaneus fractures

目的：对比解剖型钢板和锁定钢板治疗有移位的跟骨骨折的临床疗效。方法选取作者医院骨伤科2011年6月～2013年6月70例因有移位的跟骨骨折（ SandersⅡ～Ⅳ型）患者，随机分为锁定钢板组（n＝35）和解剖钢板组（n＝35）进行内固定治疗。比较两组患者的手术时间和骨折愈合时间，手术前后的Bohler和Gissane角，手术前后的跟骨长度、高度和宽度。术后半年采用Maryland评分标准对跟骨功能进行评价，同时随访半年记录并发症发生情况。结果锁定钢板组的手术时间和骨折愈合时间较解剖钢板组显著缩短（P＜0.01）；两组患者术后1周的Bohler和Gissane角均显著大于术前（P＜0.01）；锁定钢板组术后1周的Bohler和Gissane角均显著大于解剖钢板组（P＜0.01）；两组患者术后1周的跟骨长度、高度均显著大于术前，而跟骨宽度显著小于术前（ P＜0.01）；锁定钢板组术后1周的跟骨长度、高度均显著大于解剖钢板组，而跟骨宽度显著小于解剖钢板组（ P＜0.05）；锁定钢板组的优良率显著高于解剖钢板组，χ^24.8837，P＝0.0271＜0.05；两组患者的术后并发症发生率无显著差异（P＞0.05）。结论对于有移位的跟骨骨折，锁定钢板的临床疗效更佳。

Objective To compare the effect of anatomical plate and locking plate for displaced calcaneus fractures.Methods Totally 70 cases of displaced calcaneal fractures （Sanders II-IV type） in our department from Jun.2011 to Jun.2013 were selected and randomly divided into anatomical plate group （ n=35） and locking plate group （n=35）.The two groups were compared in operative time and fracture healing time ,Bohler and Gissane an-gle before and after surgery as well as heel length ,height and width of the calcaneus before and after surgery .Mary-land score was adopted to evaluate the function of the calcaneus after six months , and the follow-up complications were recorded.Results The operation time and fracture healing time were significantly shorter in the locking plate group than those in the anatomical plate group （P〈0.01）.The Bohler and Gissane angle in both groups one week after surgery were significantly greater than those before surgery （P〈0.01）.Bohler and Gissane angle in the loc-king plate group one week after the surgery were significantly greater than those in the anatomical plate group （ P〈0.01 ） .Postoperative heel length and height of the calcaneus in both groups were significantly higher than those be -fore surgery, while the width of the calcaneus was lower （P〈0.01）.Postoperative heel length and height of the calcaneus in the locking plate group were significantly higher than those in the anatomical plate group , while the width of the calcaneus was lower （P〈0.01）.The excellent and good rate of locking plate group was significantly higher than that of the anatomical plate group （χ^2=4.8837,P=0.0271〈0.05）.The incidence of the postopera-tive complications of patients in the two groups had no significant difference （ P〉0.05 ） . Conclusion For dis-placed calcaneus fractures ,locking plate has better clinical efficacy .