低切迹多向锁定与标准钢板治疗粉碎性跟骨骨折

Very low-profile variable angle locking plate versus standard locking plate for comminuted calcaneal fracture

[目的]比较低切迹多向锁定钢板(VLP)与标准锁定钢板(SLP)治疗跟骨粉碎性骨折的临床疗效。[方法]回顾性分析2011年3月~2015年1月本院收治的49例跟骨粉碎性骨折病例。依据切开复位使用的钢板类型,22例采用低切迹多向锁定钢板固定(低切迹组),27例采用标准AO锁定钢板固定(标准组)。比较两组患者AOFAS踝后足评分和影像骨折复位质量指标。[结果]两组患者均顺利手术,低切迹组2例发生切口延迟愈合,经局部换药处理后痊愈。标准组4例切口延迟愈合,其中3例经局部换药处理后痊愈,1例取出内固定清创局部皮瓣转移修复后获得治愈;另外1例腓肠神经损伤遗留局部区域皮肤麻木不适症状。术后随访36~48个月,平均(42.00±4.08)个月。末次随访时,低切迹组AOFAS评分为(81.18±7.92),而标准组AOFAS评分为(78.52±8.78),两组差异无统计学意义(P>0.05)。影像方面,两组患者术后1周的B?hler角和关节面移位均较术前显著改善(P<0.05),但相同时间点两组间差异均无统计学意义(P>0.01)。[结论]对于跟骨粉碎性骨折的切开复位内固定治疗,低切迹多向锁定钢板与标准锁定钢板相比较并没有发现显著性的优势。

[Objective] To compare the clinical results of open reduction and internal fixation(ORIF) with very low-profile variable angle locking plate(VLP) versus standard locking plate(SLP) for comminuted calcaneal fracture.[Methods] A retrospective study was conducted on 49 patients who under ORIF for comminuted calcaneal fracture in our hospital from Mar 2011 to Jan 2015. In term of implants used, 22 patients had the fractures fixed with the VLP, while the remaining 27 patients with the SLP. The AOFAS ankle-hindfoot score and quantitated parameters of fracture reduced on radiographs were compared between the two groups.[Results] All the patients had successful operations. Regarding to complication, 2 patients in the VLP group suffered from delayed incision healing, which healed well after dressing changed, whereas 4 patients in the SLP group also got delayed incision healing, which cured by dressing changed in 3 patients and debridement combined with skin flap transferred in 1 patient. Besides, 1 patients had local numbness due to sural nerve injury in the SLP group. These patients were followed up for 36~48 months with an average of(42.00±4.08) months. At the latest follow up, the AOFAS score was of(81.18±7.92) in the VLP group, while(78.52±8.78) in the SLP group, which proved not statistically significant(P>0.05). In term of radiographic assessment, the B?hler angle and displacement of articular surface significantly improved after operation compared with those preoperatively in both groups(P<0.05), although no statistically significant differences in the 2 radiographic parameters were noticed between the two group pre and postoperatively(P>0.01).[Conclusion] For open reduction and internal fixation of comminuted calcaneal fractures, the very low-profile variable angle locking plate does not prove significant advantage over the standard locking plate in this study.