Ilizarov技术与切开复位内固定治疗跟骨骨折的疗效比较

Comparison of Ilizarov technique and open reduction with internal fixation in treatment of calcaneal fracture

目的比较撬拨复位结合Ilizarov支架与切开复位内固定治疗跟骨骨折的临床疗效。方法回顾性分析2012年6月至2014年1月，手术治疗35例闭合性跟骨骨折患者资料。采用撬拨复位Ilizarov支架固定术13例，其中男9例，女4例；年龄20-51岁，平均（34．46±10．21）岁；骨折Sanders分型：Ⅱ型2例，Ⅲ型8例，Ⅳ型3例；软组织损伤Tscheme．Gotzen分度：2度9例，3度4例。采用切开复位钢板内固定术22例，其中男15例，女7例；年龄18-60岁，平均（33．59±12．07）岁；骨折Sanders分型：Ⅱ型3例，Ⅲ型15例，Ⅳ型4例；软组织损伤Tseheme—Gotzen分度：0度13例，1度9例。比较两组患者的受伤至手术时间、手术出血量、骨折愈合时间及AOFAS评分。结果术前两组病例跟骨解剖参数无统计学差异。术后患侧跟骨Bhler角支架组（27．77°±2．86°）小于钢板组（30．45°±3．45°），Gissane角支架组（131．23°±3．92°）大于钢板组（127．82。±4．65°），轴位角支架组（19．23°±2．20°）小于钢板组（22．64°±5．14°），足跟宽度支架组[（33．61±3．43）mm]小于钢板组[（36．05±3．26）mm]，以上各指标比较差异均有统计学意义；跟骨长度支架组[（63．23±5．67）mini＆于钢板组[（63．59±4．58）mm]，两组比较差异无统计学意义；受伤至手术时间支架组[（4．77±0．83）d]少于钢板组[（6．68±1．84）d]，手术出血量支架组[（45．00±6．04）m1]少于钢板组[（292．95±43．66）m1]，两组比较差异有统计学意义；骨折愈合时间支架组[（9．31±1．38）周]小于钢板组[（9．82±1．40）周]，差异无统计学意义。两组患者美国足踝外科协会（AmericanOrthopaedicFootandAnkleSociety，AOFAS）踝一后足评分，支架组为34-97分，平均（83．69±21．05）分，其中优7例，良3例，可1例，差2例，优良率为76．9％（10／13）；钢板组为37-97分，平均（79．27±19．36）分，其中优9例，良7例，可3例，差3例，优良率为72．7％（16／22）。结论对于SandersⅡ、Ⅲ型跟骨骨折及伴软组织损伤短期内不宜行切开复位内固定的SanderslV型跟骨骨折患者，Ilizarov技术是一种良好的治疗方式。

Objective To compare the clinical effect of the treatment for calcaneal fracture by percutaneous reduction combined with Ilizarov stent and open reduction and internal fixation. Methods Data of 35 patients with closed calcaneal frac- tures from June 2012 to January 2014 were respectively analyzed. 13 cases were fixed with poking reduction and Ilizarov support. Among them, there were 9 males and 4 females, aging from 20 to 51 years old （average, 34.46±10.21 years）; Sanders type Ⅱ frac- tures in 2, type Ⅲ in 8 and typeⅣ in 3; Tscheme-Gotzen 2 degree of soft tissue injury in 9 and 3 degree in 4. 22 cases were treat- ed with open reduction and internal fixation. Among them, there were 15 males and 7 females, aging from 18 to 60 years old （aver- age, 33.59±12.07 years）; Sanders type II fractures in 3, type III in 15, type IV in 4; Tscheme-Gotzen 0 degree of soft tissue injury in 13 and 1 degree in 9. Results There was no significant difference in the anatomic parameters between the two groups before operation. Postoperative calcaneal Btlhler angle of stent group （27.77°±2.86°） was less than that of the plate group （30.45°±3.45°）, and Gissane angle of stent group （131.23°±3.92°） was larger than that of the plate group （127.82°±4.65°）; axis angle of stent group （19.23°±2.20°） was less than that of the plate group （22.64°±5.14°）; calcaneal width of stent group （33.61±3.43 mm） was less than plate group （36.05±3.26 mm）, and the difference have statistical significance. The caleaneal length of the stent group （63.23±5.67 mm） was smaller than that in the plate group （63.59±4.58 mm）, but there was no significant difference. The time from the injury to surgery in stent group （4.77±0.83 d） was less than that in the plate group （6.68±1.84 d）, the blood loss of stent group （45.00±6.04 ml） was significantly less than that of the plate group （292.95±43.66 ml）. The fracture healing time of stent group （9.31 ± 1.38 week）was less than that of the steel plate group （9.82±1.40 week）, but there was no significant difference. About limb function American Orthopaedic Foot and Ankle Society （AOFAS） score, 7 cases in the stent group were excellent, 3 cases good, 1 cases fair, 2 cases poor; and 9 cases of the plate group were excellent, 7 cases good, 3 cases fair, 3 cases poor, there was no significant difference. Conclusion For the Sanders II/III type calcaneal fractures and Sanders type IV patients associated with soft tissue damage which are not suitable for open reduction and internal fixation in short term, Ilizarov technique is a good option.