Footscan足底压力分析系统对跟骨骨折术后疗效的定量评价

QUANTITATIVE EVALUATION OF POSTOPERATIVE EFFECT OF CALCANEAL FRACTURES USING FOOTSCAN SYSTEM

目的研究Footscan USB2平板式足底压力分析系统对两种内固定方法治疗跟骨骨折术后疗效的评定价值。方法2006年2月-9月,收治64例单侧新鲜闭合性跟骨骨折患者。随机分为两组,实验组32例,男28例,女4例;年龄20～53岁,平均36.7岁。病程3～14d。骨折根据Sanders分型,Ⅱ型19例,Ⅲ型11例,Ⅳ型2例。采用微创切开复位改良钢板螺栓加压内固定治疗。对照组32例,男29例,女3例;年龄18～56岁,平均37.1岁。病程4～15d。骨折根据Sanders分型,Ⅱ型18例,Ⅲ型11例,Ⅳ型3例。采用标准L形切口AO钢板内固定治疗。两组一般资料比较差异无统计学意义(P>0.05),具有可比性。分别于术后1、2年,采用FootscanUSB2平板式足底压力分析系统对两组患者行动态双足足底压力测试,比较两组患者Maryland足部功能评分情况,并对所测参数行统计学分析。结果两组患者均获2年随访,实验组未见切口感染、皮缘坏死及腓肠神经终末支损伤。对照组3例出现切口皮缘局部坏死,经换药后切口愈合;1例腓肠神经终末支损伤,局部皮肤感觉减退。术后1、2年,对照组健患足双足站立相的冲量、足弓指数、距下关节活动范围、足底压力中心外移及足跟宽度指标间差异均有统计学意义(P<0.05),实验组健患足上述指标间差异均无统计学意义(P>0.05),上述指标两组健患足间比较差异均有统计学意义(P<0.05)。术后1年实验组Maryland评分为(86.74±8.56)分,对照组为(71.24±10.06)分;术后2年实验组为(87.35±8.49)分,对照组为(72.41±9.69)分;两组组间比较差异均有统计学意义(P<0.05)。结论Footscan USB2足底压力分析系统可对跟骨骨折患者手术疗效进行定量评价;改良加压钢板内固定治疗跟骨骨折疗效优于传统AO钢板。

Objective To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures. Methods From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group： 32 patients underwent minimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old （average 36.7 years old）; the course of disease was 3-14 days; there were 19 cases of type Ⅱ, 11 of type Ⅲ, and 2 of type Ⅳaccording to Sanders fracture classification system. The control group： 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old （average 37.1 years old）; the course of disease was 4-15 days; there were 18 cases of type Ⅱ, 11 of type Ⅲ and 23 of type Ⅳ according to Sanders fracture classification system. No significant difference was noted between two groups in the general information （P 〉 0.05）. At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed. Results All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet （P 〈 0.05）, whereas in the experimental group, no significant differences were noted between the injured foot and the normal foot in terms of the above parameters （P 〉 0.05）.Significant differences were noted between two groups in terms of the above parameters （P 〈 0.05）. The Maryland score 1 year after operation was （86.74 ±8.56） points for the experimental group and （71.24 ±10.06） points for the control group; at 2 years after operation, it was increased to （87.35 ±8.49） points and （72.41 ±9.69） points, respectively, indicating there was a significant difference between two groups （P 〈 0.05）. Conclusion Operative outcomes of internal fixation with improved compressing plate are superior to those of standard AO plate. Footscan system can provide a quantitative assessment on the operative effect of calcaneus fractures.