磷酸钙骨水泥与自体骨植骨治疗Sander Ⅲ型跟骨骨折效果对比

Calcium phosphate bone cement versus autologous bone graft for sander type Ⅲ calcaneal fracture

目的对比磷酸钙骨水泥与自体骨植骨治疗SanderⅢ型跟骨骨折的效果。方法选取2010年1月—2013年10月收治的SanderⅢ型跟骨骨折患者60例，按照随机数字表法分为观察组和对照组各30例，观察组采用磷酸钙骨水泥填充，对照组采用自体髂骨植骨填充。术后抬高患肢，早期活动除踝关节外的下肢其余关节。使用抗生素预防感染3～7d，甘露醇脱水消肿3—5d，石膏固定3-4周。观察组术后4周拔除克氏针，进行患侧踝关节功能锻炼，并逐步完全负重下地行走。对照组术后8—12周拔除克氏针，进行踝关节功能锻炼并逐步负重行走。术后6个月评价临床疗效。计量资料采用t检验，计数资料采用X^2检验，P〈0．05为差异有统计学意义。结果优良率观察组80．00％，对照组53．33％，两组比较差异有统计学意义（P〈0．05）。观察组完全负重行走时间及足部功能评分[（68．44±6．89）d、（85．69±5．41）分]与对照组[（88．27±7．87）d、（71．48±4．25）分]比较差异均有统计学意义（均P〈0．05）。结论克氏针内固定结合磷酸钙骨水泥治疗SanderⅢ型跟骨骨折术后恢复快，临床疗效显著，值得推广应用。

Objective To compare the clinical efficacy of Sander type m calcaneal fracture treated by calcium phosphate bone ce-ment and autologous bone graft.Methods From June 2009 to June 2013,60 cases of Sander type Ⅲ calcaneal fracture treated in our hospital were selected and divided into observation group and control group with the method of random number table,30 cases for each group.Observation group received calcium phosphate bone cement,while control group received autologous bone graft.The affected legs were evaluated postoperatively in both groups.Early activity was carried out on the joints of lower limbs rest except the ankle joint.Antibiotics were used to prevent infection for 3-7 d,mannitol to reduce swelling for 3-5 d,and cast immobilization for 3 to 4 weeks.Kirschner wires were removed in observation group 4 weeks after surgery,functional exercises were carried out on the affected ankle joint until the patients could carry the full body weight while walking.Kirschner wires were removed in control group 8-12 weeks after surgery,functional exercises were carried out on the affected ankle joint until the patients could walk with full weight bearing.Clinical efficacy was compared in both groups six months after surgery.T-test was used for measurement data, X^2 test for count data,the result of P〈0.05 was considered statistically significant.Results The excellent rate was 80% in observa- tion group and 53.33% in control group,showing statistically significant difference（P〈0.05）.The duration of full weight-beating walking was （68.44 ± 6.89）d in observation group and （88..27 ± 7.87）d in control group;maryland foot score was（85.69 ± 5.41） points in observation and （71.48 ± 4.25）points in control group;the difference was statistically significant（P〈0.05）.Conclusion For Sander type Ⅲ calcaneal fracture,internal fixation of Kirschner wires with calcium phosphate bone cement is of rapid recovery and potent efficacy,which is worthy of clinical application.