组合式锁定接骨板的研制及其在SandersⅡ、Ⅲ型跟骨骨折治疗中的应用

A new self-designed locking plate assembly for treatment of Sander Ⅱ＆Ⅲ calcaneal fractures

目的设计一种适用于微创跗骨窦入路的组合式接骨板并探讨其在跟骨骨折治疗中的临床疗效。方法设计一种适用于微创跗骨窦入路的组合式接骨板，通过标准电机械测试仪器初步测试新型组合式接骨板生物力学性能。回顾性分析自2014年3月至2015年10月收治并均采用新型组合式接骨板经跗骨窦入路治疗的18例跟骨骨折患者资料，男14例，女4例；年龄32—66岁，平均50．4岁；均为单侧闭合性骨折，左侧7例，右侧11例；依据Sanders分型：Ⅱ型14例（IIa型8例，Ⅱb型4例，Ⅱc型2例），Ⅲ型4例（Ⅲab型2例，mae型1例，Ⅲbc型1例）。测量术前、术后3个月及末次随访时Btihler角、Gissane角以及跟骨的长度、宽度、高度，并进行比较，末次随访时采用Maryland评分系统对临床疗效进行评价。结果此新型组合式锁定接骨板可承受最大垂直纵向载荷为1396．03N，最大平面抗弯曲载荷为427．15N。500N循环应力实验中经历93003次后接骨板发生断裂。18例跟骨骨折患者术后获6．0～13．5个月（平均9．3个月）随访。术后3个月随访Bfihler角、Gissane角以及跟骨长度、宽度、高度与术前比较差异均有统计学意义（P〈0．05），术后3个月和末次随访时以上指标间比较差异均无统计学意义（P〉0．05）。末次随访时Maryland足部评分：优12例，良3例，中3例。无一例患者发生切口感染、内固定装置松动或断裂、骨折不愈合或畸形愈合等。结论适用于跗骨窦入路的新型组合式接骨板具有放置简单、可坚强固定、足部功能恢复满意并且有效减少术中损伤及术后切口并发症等诸多优点，具有较高的临床应用价值。

Objective To report a new self-designed locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders typesⅡ＆Ⅲ via sinus tarsi approach. Methods We designed a new locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ＆Ⅲ via sinus tarsi approach. Its biomechanical performance was tested by standard electronic and mechanical devices. From March 2014 to October 2015, 18 patients with displaced calcaneal fracture were treated with our self-designed new locking plate assembly. They were 14 men and 4 women, aged from 32 to 66 years （average, 50.4 years）. All the fractures were unilateral closed ones, with 7 cases of the left side and Ⅱ ones of the right side. By the Sanders classification, 14 cases belonged to type Ⅱ （8 to type Ha, 4 to type lib and 2 to type I/c） and 4 to type Ⅲ（2 to type lllab, one to type lllac and one to type Ⅲbc）. The Bfihler angle, Gissane angle, and height, width and length of the calcaneus were measured and compared at preoperation,postoperative 3 months and final follow-ups. The clinical outcomes were evaluated using Maryland foot score system atfinal follow-ups. Results This new locking plate assembly could tolerate a maximum vertical load of 1,396. 03 N and a maximum horizontal anti-bending load of 427. 15 N. It broke after it had been subjected to 93, 003 loadings in a repeated 500 N stress test. All the 18 patients were followed-up for an average of 9.3 months （from 6. 0 to 13.5 months）. Follow-ups at 3 months postoperation showed significant improvements in Bt^hler and Gissane angles and calcaneal height, width and length compared with pre-operative parameters （ P 〈 0.05）, but no significant differences were observed in the above parameters between 3 and final follow-ups postoperation （ P 〉 0. 05） . Maryland foot scores demonstrated 12 excellent cases, 3 good ones and 3 fair ones. No incision infection, implant failure, nonunion or malunion happened in this series. Conclusions This new locking plate assembly suitable for sinus tarsi approach can be used in clinic because it has advantages of easy placement, rigid fixation, satisfactory functional recovery of the foot and limited complications.