可塑性钛板内固定治疗跟骨关节内骨折临床研究

Clinical Study on Internal Fixation with Plastic Titanic Plate for Intra-articular Fracture of Calcaneus

目的探讨可塑性钛板在跟骨关节内骨折中的应用价值。方法采用关节内骨折切开复位可塑性钛板内固定治疗42例(49足)跟骨关节内骨折,其中SandersⅡ型11足,Ⅲ型23足,Ⅳ型15足。术后进行3～36个月随访,观察患足功能恢复情况及评定临床疗效。结果出现切口皮缘部分坏死4例,足外缘皮肤感觉麻木2例,骨折复位不佳者2例。与术前相比,术后跟骨侧轴位X线片显示跟骨Bohler角、Gissane角及距下后关节面均得到了良好的恢复(P<0.001)。按照Kerr评定标准,临床疗效平均优良率为81.63%,SandersⅡ型、Ⅲ型和Ⅳ型优良率分别为90.91%、86.96%和66.67%,三种类型优良率呈下降趋势,但组间差异均无统计学意义(P>0.05)。结论切开复位可塑性钛板内固定是治疗跟骨关节内骨折的可靠方法。恢复跟骨解剖形态、掌握好手术指征和手术时机、选择合适的可塑性钛板固定能最大限度地减少骨折后并发症。

Objective To investigate the application value of plastic titanic plate for intra - articular fracture of calcaneus. Methods Forty- two patients （49 feet） with intra- articular calcaneal fracture were treated with open reduction and internal fixation with plastic titanic plate. According to Roy sanders classification, 11feet were classified as Sanders type Ⅱ , 23 feet as type Ⅲ , and 15 feet as type Ⅳ. They were followed up for 3--36 months, and the status of feet functional rehabilitation was observed and the treatment effects were evaluated. Results After follow- up, 4 patients were found with parts of skin margin necrosis, 2 with feet margin cutaneous sensation anesthesia, 2 with fracture reset not excellent. Compared with the preoperative group, in the postoperative group at calcaneal bone rachlet view, X - ray films showed that Bohler angle, Gissane angle and below and posterior articular facet of calcaneal bone were recovered significantly satisfactorily （P 〈 0.001）. According to Kerr evaluation standards, the mean good and excellent rate was 81.63 %. The good and excellent rates of Sanders typeⅡ , type Ⅲ and type IV were 90.91%, 86.96% and 66.67%, respectively. There was de- creasing tendency of the good and excellent rates in three types groups. But there was no statistical significance between the three groups （P 〉 0.05）. Conclusion The open reduction and internal fixation with plastic titanic plate is reliable to treat intra - articular caleaneus fractures. Restoring the articular anatomy, mastering well operation indication and opportunity and choosing the appropriate plastic titanic blare internal fixation can greatly decrease complications of calcaneal fracture.