普通解剖钢板加植骨与锁定钢板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效比较

Comparison between normal anatomic plate with bone graft and locking plate in treatment of calcaneal fractures of Sanders types Ⅱ＆ Ⅲ

目的 比较普通解剖钢板加自体髂骨植骨与锁定钢板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效. 方法 对2010年8月至2013年l2月收治的68例Sanders Ⅱ、Ⅲ型跟骨骨折患者资料进行回顾性研究,根据治疗方式不同分为普通解剖钢板加自体髂骨植骨组（植骨组,36例）和锁定钢板组（非植骨组,32例）.两组患者术前一般资料比较差异均无统计学意义（P＞0.05）,具有可比性.记录并比较两组患者手术时间、术后引流量、住院时间、非负重下地时间、完全负重时间、并发症发生率、B（o）hler角、Gissane角、跟骨长度、宽度、高度及Maryland足功能评分优良率. 结果 所有患者术后骨折愈合良好,均未出现术后感染、皮肤坏死及伤口不愈合.发生跟痛症状和跟腓撞击综合征的发生率比较差异均无统计学意义（P＞ 0.05）.与非植骨组比较,植骨组的手术时间、住院时间、术后非负重下地时间都更长,差异均有统计学意义（P＜0.05）;两组的术后引流量、完全负重时间差异无统计学意义（P＞0.05）.所有患者术后1年的B（o）hler角、Gissane角,跟骨长度、宽度、高度与术前比较差异均有统计学意义（P＞0.05）,但两组之间比较差异均无统计学意义（P＞ 0.05）.两组Maryland足部评分优良率比较差异无统计学意义（P＞0.05）. 结论 采用锁定钢板不植骨相比采用普通钢板加自体髂骨植骨在复位效果及优良率方面无明显差异,考虑到采用锁定钢板不植骨为治疗方式避免了髂骨取骨区术后疼痛、感染、血肿以及患者不适感等并发症,在治疗SandersⅡ、Ⅲ型跟骨骨折方面具有一定优势.

Objective To compare the clinical efficacy between calcaneal anatomic plate ＋ autologous bone graft and calcaneal locking plate in treatment of calcaneal fractures of Sanders types Ⅱ ＆ Ⅲ.Methods The current study recruited 68 cases of calcaneal fractures of Sanders types Ⅱ ＆Ⅲ who had been treated in our hospital from August 2010 to December 2013.The patients were treated either by ordinary calcaneal anatomic plate plus autologous iliac bone graft （36 cases） or by calcaneal locking plate （32 cases）.The general clinical data were compatible between the 2 groups （P 〈 0.05）.The 2 groups were compared in terms of operation time,postoperative drainage,hospital stay,non-bearing ambulant time,full bearing time,postoperative complications,B（o）hler angle,Gissane angle,the length,width and height of the calcaneus,and the Maryland scores of the foot function.Results All the patients achieved fine fracture union without postoperative infection,skin necrosis or wound dehiscence.There was no significant difference between the 2 groups in incidences of postoperative calcaneal pain or calcaneofibular impingement syndrome （P 〉 0.05）.The bone graft group needed significantly longer operation time,non-bearing ambulant time and hospital stay than the locking plate group （P 〈 0.05）.There were no significant differences between the 2 groups in postoperative drainage or full bearing time （P 〉 0.05）.There were significant differences between pre-operation and one year post-operation in B（o）hler angle,Gissane angle,and the length,width and height of the calcaneus （P 〈 0.05）,but not between the 2 groups （P 〉 0.05）.The 2 groups showed insignificant differences in the Maryland scores of the foot function either （P 〉 0.05）.Conclusion In treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ,compared with ordinary plate ＋ autologous bone graft,locking plate without bone graft may reduce the incidences of post-operative pain caused by iliac bone graft,infection,hematoma,and other complications but shows no obvious advantages in calcaneal reduction or foot function.