可塑性异形钛钢板在跟骨粉碎性骨折治疗中的应用

目的：评价可塑性异形钛钢板治疗跟骨粉碎性骨折的疗效。方法：对45例跟骨粉碎性骨折采用切开复位可塑性异形钛钢板内固定技术治疗,本组45例（48足）,男36例,女9例;年龄25-66岁,平均年龄34岁。双侧跟骨粉碎性骨折患者共有3例,单侧共42例。单侧骨折的患者中19例发生在左侧,23例发生在右侧。造成损伤的原因有以下几类：27例为高处坠落伤,13例车祸伤,2例压砸伤。按Sanders分型：19足属于Ⅱ型,20足属于Ⅲ型,9足属于Ⅳ型。骨折均波及距下关节并有移位,骨折创面新鲜并且属于闭合性骨折。受伤至就诊的时间间隔为1小时-7天,平均间隔时间为6小时。为了了解三维结构受损情况,所有患者术前均进行了影像学检查,包括跟骨侧位、轴位X线片及冠状位CT扫描,并采用Maryland足部评分标准评估疗效。结果：对45例患者进行随访,时间为5-24个月,平均随访时间为12个月。所有患者的骨折均愈合,愈合平均时间为11周。术后均行X线片检查显示：跟骨形态以及关节面恢复满意,术后测量Bohler角平均28.9°,Gissane角平均132.3°。随访期内无感染、跟骨关节面无塌陷、骨折移位、内固定物松动、断裂等并发症。足功能优良率93.7%。术后并发症：所有患者均未出现感染情况,其中3例患者术后发生部分皮缘坏死,经持续换药,自行愈合,2例发生创伤性关节炎。结论：可塑性异形钛钢板治疗跟骨粉碎性骨折具有操作简便、固定牢靠、疗效确切等优点,是一种理想的内固定方法。

Objective：Evaluate the experi-enceof plasticity shaped titanium plate cal-caneal fractures.Methods：Select 45 cases of calcaneal fractures treat with open reduction and plasticity shaped titanium plate fixation from March 2008 to March 2011.The group of 45 patients （48 feet）,36 males and 9 fe-males;range 25 to 66 years old,with an aver-age age of 34 years old.The group of 45 pa-tients （48 feet）,36 males and 9 females; Range 25 to 66 years,with an average age of 34 years old.Three patients have bilateral calcaneal fractures,and 42 cases have uni-lateral.19 patients with unilateral fractures occurred in the left,23 cases occurred in the right side.Cause of the loss as follow：27 cas-es of falls injury,13 cases of traffic accident, two cases of crushing injury.By Sanders classification：19 feet belong to type Ⅱ,20 feet belong to type Ⅲ,9 feet belong to Ⅳ type.Subtalar joint fractures were affected and displaced ,fracture wounds are fresh and closed fractures.Range froml hour to 7 days bettwen injury and treatment,an aver-age interval is 6 hours.In order to under-stand the three-dimensional structure of the damage,all patients underwent a radiograph-ic examination,including the calcaneus lat-eral,axial and coronal X-ray CT scan and evaluate the use of Maryland Foot Score effi-cacy.Resuhs：45 patients were followed up for 5 to 24 months, with an average fol- low-up time was 12 months.All patients with fractures were healed an average time of 11 weeks.Postoperative underwent X-ray examination showed：calcaneal articular sur-face morphology and satisfactory recovery, postoperative Bohler angle measuring aver- age 28.9° ,Gissane average angle of 132.3° .No follow-up period of infection,no collapse of the articular surface of the calca- neus,fraeture displacement,internal fixation loosening,fracture and other complications. Foot feature excellent rate of 93.7%.Postop- erative eomplieations：infeetion does not ap-pear, three patients were partial skin flap necrosis by continuous dressing,self-heal-ing, two eases of traumatic arthritis.Conclu-sion：Plasticity shaped titanium plate ealea-neal fractures is a simple,stable fixation,the advantages of the exact effect, is an ideal method of internal fixation,worthy of clinical application.