传统解剖钢板联合自体植骨与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折中治疗效果和安全性差异

The difference of therapeutic effect and security between traditional anatomic plate combined with autologous bone graft and locking plate for Sanders types Ⅱ, Ⅲ calcaneal fractures

目的探讨分析传统解剖钢板联合自体植骨与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折中治疗效果和安全性差异。方法选择东莞市中医院收治的60例SandersⅡ、Ⅲ型跟骨骨折患者作为本次研究对象,根据治疗方式分为观察组和对照组,各组30例患者。观察组患者予以锁定钢板非植骨疗法,对照组患者予以传统解剖钢板联合自体植骨疗法;随访12个月,比较两组患者的手术情况、术后并发症、Bohler、Gissane角、跟骨高度、长度、高度及Maryland评分之间的差异。结果两组患者的术后引流量及完全负重时间差异无统计学意义(P>0.05)。观察组患者的手术时间、术后非负重下地时间及出院时间分别为(65.1±10.3)m L、(4.7±2.1)d、(13.6±1.2)d,明显少于对照组的(80.3±8.2)m L、(8.5±1.6)d、(16.1±0.8)d,差异均有统计学意义(P<0.05);对照组中有7例患者出现取骨区疼痛,与观察组差异具有明显的统计学意义(P<0.05);两组患者术前、后的Bohler、Gissane角、跟骨高度、长度及高度间的差异均无统计学意义(P>0.05),但术后12个月,两组患者的Bohler、Gissane角、跟骨宽度、长度及高度均明显大于治疗前,差异均具有统计学意义(P<0.05);两组患者Maryland评分优良率差异无统计学意义(P>0.05)。结论传统解剖钢板联合自体植骨疗法与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折的治疗中治疗效果无明显差异,均具有较好的复位效果及跟骨功能恢复,但锁定钢板非植骨疗法具有术后恢复更快的优势,且无传统解剖钢板联合自体植骨疗法导致的取骨区疼痛等不良反应,故锁定钢板非植骨疗法具有可靠的安全性和良好的疗效。

Objective To discuss the difference of therapeutic effect and security between traditional anatomic plate combined with antologous bone graft and locking plate for Sanders types Ⅱ、Ⅲ calcaneal fractures. Methods 60 patients with Sanders types Ⅱof Ⅲ calcaneal fractures treated in the Dongguan Hospital of Traditional Chinese Medicine were selected as the research objects, and were divided into the observation group and the control group according to the treatment method, each of 30 cases. The observation group was treated with locking plate, and the control group was treated with traditional anatomical steel plate combined with autologous hone graft. Followed-up for 12 months, the surgery situation, postoperative complications, Bohler angle, Gissane angle, heel width, heel length, heel height and Maryland scores of two groups were compared. Results The differences of postoperative drainage and full weight-bearing time of two groups were not statistically significant （ P 〉 0.05 ）. The operation time, non weight bearing ambulant time and hospital stay of the observation group were respectively （ 65.1 ± 10.3 ） mL, （ 4.7± 2.1 ） d, （ 13.6± 1.2 ） d, and those of the control group were （ 80.3 ± 8.2 ） mL, （ 8.5 ± 1.6 ） d, （ 16.1 ±0.8 ） d, and the differences were statistically significant （ P 〈 0.05 ）. The differences of Maryland scores excellent rates of two groups were not statistically significant （ P 〉 0.05 ）. Conclusion Traditional anatomical steel plate combined with autologous bone graft and locking plate for Sanders Ⅱof Ⅲ calcaneal have similar therapeutic effect, both have good restoration effect and calcaneal function recovery, but patients treated with locking plate therapy recovery faster after operation and without the pain in the took bone area, so the locking plate has reliable security and effect.