解剖钢板内固定并植骨治疗跟骨骨折骨缺损的临床研究

Clinical Research of Calcaneus Fracture Treated by Anatomy Armor Plate Combining with Bone Transplant

目的探讨解剖钢板内固定、内固定并自体植骨、内固定并同种异体骨植骨3种手术方法治疗跟骨骨折骨缺损的临床疗效。方法对129足跟骨骨折骨缺损按照治疗方法分组。A组:钢板内固定36足;B组:内固定并自体骨48足,C组:内固定并异体骨45足。全部病例按Sanders分型:A组Ⅱ型骨折10足,Ⅲ型17足,Ⅳ型9足;B组Ⅱ型骨折12足,Ⅲ型23足,Ⅳ型13足;C组Ⅱ型骨折9足,Ⅲ型21足,Ⅳ型15足。手术前后对Bohler角、Gissane角、跟骨水平全长、丘部总高、轴长和体宽等多项指标进行比较,按Marryland评分系统评价术后功能。结果术后A组3例切口延迟愈合,1例腓肠皮神经损伤,1例腓骨长短肌腱滑脱。术后功能评价:A组优16足,良15足,可5足,优良率86.11%。B组1例切口延迟愈合,1例腓肠皮神经损伤;优30足,良14足,可4足,优良率91.67%。C组2例切口延迟愈合,1例腓骨长短肌腱滑脱;优28足,良14足,可3足,优良率93.33%。结论自体植骨和异体植骨结合内固定与单纯钢板内固定在治疗严重跟骨骨折远期疗效上差异有统计学意义,自体植骨内固定和异体植骨内固定疗效差异无统计学意义。

Objective To compare respective treatment of calcaneus fracture treated by anatomic plate and anatomic plate combining with autogenous,allograft bone.Methods One hundred and twenty-nine cases during January 1999-January 2007 were divided into groups according to treatment measure.A group：36 cases anatomic plate;B group：48 cases anatomic plate combining with autogenous iliac bone transplant;C group：45 cases anatomy armor plate combining with allograft bone.All cases were followed up at least 24 months.Lateral and axial radiographs and CT axial scans of atlases were performed in all patients.All cases were classified according to Sanders classification.A group：type Ⅱ10 cases,type Ⅲ 17 cases,type Ⅳ 9 cases;B group：type Ⅱ12 cases,type Ⅲ 23 cases,type Ⅳ 13 cases;C group：type Ⅱ9 cases,type Ⅲ 21 cases,type Ⅳ 15 cases.Targets were observed such as Bohler angle,Gissane＇s angle,the level length,the height in hillock,the axis length,body breadth.Post-operation function was evaluated by Marryland evaluation criteria of calcaneus fracture.Results Postoperatively A group：16 were excellent cases,15 good cases,5 fair cases.Three cases incision delayed cicatrization,One case suralis nerve injury,1 case peroneus longus -brevis surge;excellent and good rate was 86.11 percent.B group：30 were excellent cases,14 good cases,4 fair cases.One incision delayed cicatrization,1 suralis nerve injury;excellent and good rate was 91.69 percent.C group：28 excellent Two cases,14 good cases,3 fair cases.Two cases incision delayed cicatrization,1 case peroneus longus -brevis surge;excellent and good rate was 90.36 percent.Conclusion The long-term effect of B group,C group is significant statistical different from A group.