植骨与非植骨治疗Sanders Ⅱ、Ⅲ型跟骨骨折远期疗效比较

The long-term efficacy comparison of the treatment for Sanders Ⅱ and Ⅲ calcaneal fractures with or without bone graft

目的对比分析植骨与非植骨联合解剖型跟骨钛板治疗SandersⅡ、Ⅲ型跟骨骨折的远期疗效。方法选取郑州市第一人民医院2011年4月至2014年12月期间收治的144例跟骨骨折病人,其中非植骨组76例,植骨组68例(自体骨或同种异体骨一期植入骨缺损区),均予切开复位加解剖型跟骨钛板内固定。术后对所有病人进行定期随访,收集影像学及临床资料。比较末次随访时患足功能(Kofoed评分及Maryland评分)、Bohler角和Gissane角。结果 144例病人均获得随访,最长随访时间5年,随访时间(3.4±1.1)年。末次随访时,两组病人的Maryland评分分别为(84.4±11.2)分和(81.7±9.4)分,组间比较差异无统计学意义(t=1.459,P=0.154);Kofoed评分分别为(81.4±10.7)分和(82.5±8.8)分,组间比较差异无统计学意义(t=1.098,P=0.280);末次随访时,非植骨组Bohler角和Gissane角分别为32.7°±2.1°和137.1°±7.2°,植骨组Bohler角和Gissane角分别为31.6°±3.2°和134.1°±6.8°;与术前相比,差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05)。结论对于SandersⅡ、Ⅲ型跟骨骨折,良好的复位固定结合术后正规康复锻炼是获得患足最佳功能的关键因素,术中是否植骨与患足远期功能并无直接关联。

Objective To compare and evaluate the long-term efficacy of SandersⅡandⅢcalcaneal fractures treated by anatomical plates with or without bone graft.Methods A total of 144 patients with SandersⅡandⅢcalcaneal fractures in Zhengzhou First People's Hospital from April 2011 to December 2014 were divided into the bone graft group with 68 patients and non-bone graft group with 76 patients.All cases were treated with open reduction and anatomic titanium plate fixation.The patients were followed up regularly for 5 years.The foot function(Kofoed score system and Maryland score system was used),Bohler angle and Gissane angle of the patients at last follow-up were compared.Results All 144 patients were followed up with complete·884·安徽医药Anhui Medical and Pharmaceutical Journal 2019 May,23(5)data.The longest follow-up time was 5 years,and the average time was(3.4±1.1)years.At the end point,Maryland score of the two groups were 84.4±11.2 and 81.7±9.4,and the difference was not statistically significant(t=1.459,P=0.154);Kofoed score of the two groups were(81.4±10.7)and(82.5±8.8),and the difference was not statistically significant(t=1.098,P=0.280).At the end point,Bohler angle and Gissane angle of the non-bone group were(32.7°±2.1°)and(137.1°±7.2°);Bohler angle and Gissane angle of the bone group were(31.6°±3.2°)和(134.1°±6.8°).Compared with the preoperative status,Bohler angle and Gissane angle improved significantly,but there were no significant differences between groups(P>0.05)at the end point.Conclusion For SandersⅡandⅢcalcaneal fracture,good reduction and fixation combined with postoperative rehabilitation are the key factors to obtain the optimal function of the affected foot,and there is no direct connection between the long-term efficacy and bone graft group in the operation.