Sanders Ⅱ、Ⅲ型跟骨骨折常规解剖钢板与掀开跟骨外侧骨瓣可吸收钉治疗疗效对比

Comparison between normal anatomic plate and absorbable screw with opening lateral bone flap in treatment of calcaneal fractures of Sanders Ⅱ and Ⅲ

目的比较"掀开跟骨外侧骨瓣+可吸收钉+加植骨"与"常规外侧切口钢板+植骨"治疗SandersⅡ、Ⅲ型跟骨骨折疗效。方法回顾分析宁波市第六医院2011年2月—2014年2月76例SandersⅡ、Ⅲ型跟骨骨折(均为单侧骨折),行"掀开跟骨外侧骨瓣+可吸收钉或+植骨"的40例患者设为A组,行"常规外侧切口钢板+植骨"治疗跟骨骨折的36例患者设为B组。比较2组患者手术时间、术中出血量、术后引流量、并发症发生率、Bohler角、Gissane角、AOFAS(ankle-hindfoot scale)评分、MFS(maryland foot score)评分。结果所有患者均获得随访,随访时间为24~36个月(平均28个月)。与B组相比较,A组手术时间更短,术中出血量、术后引流量、术后并发症更少,差异均有统计学意义(均P<0.05);所有患者术后1年、2年Bohler角、Gissane角与术前比较差异均有统计学意义(均P<0.05),A组与B组之间比较差异无统计学意义(P>0.05);2组术后AOFAS评分和MFS评分比较差异无统计学意义(P>0.05)。结论应用"掀开跟骨外侧骨瓣+可吸收钉+植骨"治疗SandersⅡ、Ⅲ型跟骨骨折,相对"常规外侧切口钢板+植骨"组手术效果安全可靠,手术时间短,术中创伤小,出血少,术后并发症较少。

Objective To compare the clinical efficacy between normal anatomic plate ＋ bone graft and absorbable screw ＋ opening lateral bone flap ＋ bone graft in treatment of calcaneal fractures of Sanders Ⅱ and Ⅲ. Methods From February,2011 to February,2014,76 patients of Sanders type Ⅱ and Ⅲ of calcaneal fractures were treated in our department. Forty patients received absorbable screw ＋ opening lateral bone flap ＋ bone graft were assigned into Group A,while 36 patients received normal anatomic plate ＋ bone graft into Group B. The two groups were compared in terms of operation time,bleeding volume,postoperative drainage,postoperative complication,Bohler angle,Gissane angle,Ankle-Hindfoot Scale（ AOFAS） and Maryland foot score（ MFS）. Results The patients were followed up for 24 to 36 months with an average of 28 months. The Group A had less operation time,bleeding volume,postoperative drainage and postoperative complication（ P〈 0. 05）. There were significant differences in Bohler angle and Gissane angle one year and two year after the operation as compared with those before the operation（ P〈 0. 05）,but not between the two groups（ P〈 0. 05）. There were no significant difference in postoperative AOFAS and MFS（ P〉 0. 05）. Conclusion It is safe and effective to treat calcaneal fractures of Sanders Ⅱ and Ⅲ with absorbable screw ＋ opening lateral bone flap ＋ bone graft. Compared with normal anatomic plate ＋ bone graft,it has less operation time,bleeding volume,operation invasion,postoperative complication.