解剖钢板＋加压骨栓内固定顺势治疗移位跟骨关节内骨折

Homeopathic closed leverage anatomical plate with compression bolt for treatment of displaced intra-articular calcaneal fractures

目的比较闭合撬拨、后外侧小切口解剖钢板、加压骨栓内固定顺势治疗与传统切开复位内固定治疗移位的跟骨关节内骨折的疗效。方法采用回顾性病例对照研究分析2012年9月-2015年5月收治的98例移位跟骨关节内骨折患者临床资料。按随机数字表法分为研究组和对照组。研究组58例（66侧），其中男50例，女8例；年龄27—56岁，平均41．9岁。Sanders分型：Ⅱ型40侧，Ⅲ型24侧，Ⅳ型2侧。对照组40例（45侧），其中男36例，女4例，年龄25～58岁，平均43．7岁。Sanders分型：Ⅱ型25侧，Ⅲ型18侧，Ⅳ型2侧。研究组采用闭合撬拔、后外侧小切口解剖钢板、加压骨栓内固定顺势治疗，对照组采用传统“L”形切口切开复位内固定治疗。记录手术时间；术后影像学检查解剖复位情况、Boehler角、跟骨宽度；观察切口愈合情况；末次随访按照Maryland后足功能评价标准评估功能恢复情况。结果研究组手术时间为（52．6±11．2）min，对照组为（86．4±14．1）min（P〈0．01）。患者均获随访18～50个月，平均30．8个月。研究组53侧（80％）跟骨后关节面复位满意（关节面移位〈3mm），对照组38侧（84％）复位满意（P〉0．05）。研究组Boehler角为（28．0±6．2）。，对照组为（26．8±7．0）。（P〉0．05）；研究组跟骨宽度为（31．3±3．6）mm，对照组为（34．9±4．0）mm（P〈0．01）。所有跟骨外形恢复满意，无外侧撞击综合征。研究组无切口感染或皮缘坏死；对照组2侧浅表切口感染，3侧皮缘坏死，均经换药治愈（P〈0．01）。末次随访时Maryland后足功能评分：研究组为（87．1±7．6）分，对照组为（84．9±9．1）分（P〉0．05）。结论闭合撬拨、外侧小切口解剖钢板、加压骨栓内固定顺势治疗是移位跟骨关节内骨折的有效治疗方法，具有创伤小、手术时间短、复位质量好、软组织并发症少等优点。

Objective To compare the treatment of displaced intra-articular calcaneal fractures by homeopathic closed leverage anatomical plate with compression bolt through small posterior lateral approach vs. traditional open reduction and internal fixation. Methods A retrospective case control study was made on 98 cases of displaced intra-articular calcaneal fractures admitted from September 2012 to May 2015. According to the random number table, the subjects were assigned to homeopathic closed leverage anatomical plating with compression bolt through small posterior lateral approach （ experiment group, 58 cases, 66 sides） and open reduction and internal fixation through L-shape approach （control group, 40 cases, 45 sides）. Experiment group consisted of 50 male and eight females cases aging from 27-56 years （mean, 41.9 years） , and the Sanders classification was 40 cases of type Ⅱ , 24 type Ⅲ and two type Ⅳ. Control group consisted of 36 male and four female cases aging from 25-58 years （mean, 43.7 years） , and the Sanders classification was 25 cases of type 11, 18 type m and two type IV. Operation time, bone reduction, postoperative Bohler＇s angle, width of the calcaneum, and incision healing were recorded. Functional outcomes were evaluated with Maryland hindfoot scoring system at last follow-up. Results Operation time was （ 52.6± 11.2） rain in experiment group, significantly shorter than that in control group [ （ 86.4± 14.1） mini （ P 〈 0.01 ）. All cases were followed up from 18-50 months （mean, 30. 8 months）. Reduction of the calcaneal posterior facet in 53 sides （80%） was graded as nearly anatomical in experiment group, and 38 sides （ 84% ） in control group （ P 〉 0.05 ）. Postoperative B^hler＇s angle was （28.0 ± 6.2） ° in experiment group, and （26.8 ± 7.0） in control group （ P 〉 0.05 ）. Width of the calcaneum was （31.3 ±3.6 ） mm in experiment group and （ 34.9± 4.0 ）mm in control group （ P 〈 0.01 ）. All cases presented satisfactory shape of the calcaneus without lateral-side impact syndrome. No case had wound infection and incision-edge necrosis in experimental group, while two cases of superficial wound infection and three cases of incision-edge necrosis were found in control group （ P 〈 0.01 ）. At last follow-up, Maryland hindfoot score was （ 87.1 ± 7.6） points in experiment group and （ 84.9 ± 9.1 ） points in control group （ P 〉 0.05 ）. Conclusion Homeopathic percutaneous leverage and anatomical plate with compression holt through small posterior lateral approach is an effective method for treatment of displaced intra-articular calcaneal fractures, for it has advantages of minimal invasion, less operation time, good reduction and function, and less wound complications.