小蝶形钛钢板的研制及其在跟骨关节内骨折手术中的应用

Design and application of small butterfly-shaped plate for treatment of intra-articular calcaneal fractures

目的介绍小蝶形钛钢板的研制及其在跟骨关节内骨折手术中的应用,并探讨其适应证及优缺点。方法2001年2月-2004年4月,采用小切口和小蝶形钢板对22例26侧跟骨关节内骨折进行切开复位内固定治疗,男16例19足,女6例7足;年龄23～61岁,平均36.8岁。单侧跟骨18例18足,双侧跟骨4例8足;左足11侧,右足15侧。损伤原因高处坠落伤20例24足,交通伤2例2足。骨折分型按Sanders方法,Ⅱ型12足(Ⅱa3足,Ⅱb7足,Ⅱc2足),Ⅲ型14足(Ⅲab5足,Ⅲac7足,Ⅲbc2足)。结果17例21足获得随访,时间为12～34个月,平均19.2个月。按Maryland足评分方法(Maryland Foot Score)评价术后功能Ⅱ型骨折9足,优7足,良2足;Ⅲ型12足,优6足,良5足,可1足。所有的足外形恢复正常,能够穿正常鞋,无跛行。X线检查示B hler角、Gissane角、距骨倾斜、跟骨宽度及丘部高度基本恢复正常,无明显并发症。结论小蝶形钛钢板适用于SandersⅡ和Ⅲ型跟骨骨折的手术治疗,具有操作简单、固定可靠、并发症少和临床疗效好等优点。

Objective To design small butterfly-shape plate, applyit to treat intra-articular calcaneal fractures and discuss its clinical indications, advantages and disadvantages. Methods Open reduction and internal fixation via small incision with small butterfly-shape plate were performed from February 2001 to April 2004 on 22 cases （26 sides） with intra-articular calcaneal fractures including 16 males （19 feet） and six females （seven feet） , with average age of 36.8 years （23-61 years）. There were 18 cases （18 feet） with unilateral fractures, four （eight feet） with bilateral fractures, Ⅱ left feet fractures and 15 right feet fractures. The injury causes included fall from a height （20 cases, 24 feet） and traffic accidents （ two cases, two feet）. According to Sanders classification, there were 12 feet of type Ⅱ （ three type lia, seven type lib and two type Ⅱc） and 14 feet of type Ⅲ （five mab, seven mac and two Ⅲ bc ）. Results Seventeen cases （21 feet） were followed up for average 19.2 months （ 12-34 months）. Maryland foot score system showed that nine feet with type Ⅱ fractures obtained excellent results in seven and good in two and that 12 feet of type Ⅲ fractures won excellent results in six, good in five and fair in one. All cases with foot shape restored to normal could wear regular shoes, without lame. Plain radiographs showed basic restoration of Boehler＇ s angle, Gissane＇ s angle, talus inclining angle, caleaneal width and height of the thalamus, with insignificant complications. Conclusion The small butterflyshape plate is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of reliable fixation, simple operation, few complications and good clinical results.