松质骨螺钉与加压螺栓在微创钢板治疗跟骨骨折中应用的病例对照研究

Case-control study on cancellous screw and compression bolt in the treatment of calcaneal fractures wih minimally invasive plate

目的:探讨采用斯氏针撬拨复位,足跟外侧微创小切口钢板全螺纹松质骨钉内固定治疗跟骨关节内移位骨折的临床疗效。方法:2009年9月至2012年6月共收治80例闭合性跟骨关节内移位骨折患者,分为对照组和治疗组,每组40例。对照组:男21例,女19例;年龄23～64岁,平均(39.1±11.7)岁;采用自断型加压螺栓钢板内固定。治疗组:男24例,女16例;年龄21～67岁,平均(39.6±14.3)岁;应用全螺纹松质骨螺钉钢板内固定。记录术中松质骨螺钉与加压螺栓进行固定的时间及手术的出血量,观察术后足底内侧神经的损伤例数,术后1年复查时测量B觟hler角和Gissane角以及跟骨的宽度的矫正度数,1年后行内固定物取出,应用AOFAS踝-后足评分标准评定疗效。结果:患者术后均获得随访,时间9～32个月,平均16个月。治疗组手术时间短、创伤小,术后B觟hler角及跟骨宽度恢复满意,减少了足内侧神经血管损伤,骨折愈合后易于取出,与对照组比较差异有统计学意义。结论:全螺纹松质骨螺钉替代自断型加压螺栓固定跟骨骨折临床疗效相同,但手术时间缩短、出血少、易于取出,避免了内侧神经血管的损伤,降低了并发症的发生。

Objective ：To evaluate percutaneous reduction by Kirschner pin and internal fixation with cancellous screw and plate through minimal incision at the lateral side of heel for the treatment of intra-articular displacement fracture of calca- neus. Methods：From September 2009 to June 2012,80 patients with close intra-articular displacement fractures of calcaneus were divided into treatment group and control group. There were 40 patients in the control group, including 21 males and 19 females, ranging in age from 23 to 64 years old, averaged （39.1±11.7） years old;and the patients were treated with fixation by compress screws and plates of self-broken type. There were 40 patients in the treatment group,including 24 males and 16 fe- males, ranging in age from 21 to 67 years old, averaged （39.6±14.3）years old;and the patients were treated with full thread cancellous screws and plates fixation. The fixation time ,intra-operative blood loss and the number of injured medial plantar nerve were compared between the two groups. The Bohler angle, Gissane angle and the correction degree of calcaneal width were measured at 1 year after operation. The internal fixators were taken out after 1 year. The AOFAS ankle-hindfoot score was used to evaluate therapeutic effects. Results：All the patients were followed up, and the duration ranged from 9 to 32 months, with a mean of 16 months. There were shorter operation time,less injury,satisfactory postoperative B^hler angle and calcaneal width in treatment group compared with control group, which reduced the medial neurovascular injuries, and the plate was eas- ily removed after fracture healing. Conclusion： Full thread cancellous screws and plate fixation for the treatment of calcaneal fractures could get same therapeutic effects as compress screws and plate of self-broken type fixation, and also has follow ad- vantages ： shortening the operation time, reducing blood loss, easily to be removed, avoiding the medial neurovascular damage, reducing the incidence of complications.