解剖锁定与普通钢板治疗闭合SandersⅡ、Ⅲ型跟骨骨折的病例对照研究

Case-control study on anatomical locking plate and ordinary steel plate for the treatment of closed calcaneal fracture with Sanders Ⅱ and Ⅲ

目的:比较解剖锁定钢板(anatomical locking plate,ALP)与普通钢板(ordinary steel plate,OSP)治疗闭合SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法:回顾性分析2016年5月至2018年5月收治的68例闭合SandersⅡ、Ⅲ型跟骨骨折患者,根据内固定方式不同分为解剖锁定钢板内固定组(ALP组)和普通钢板内固定组(OSP组),每组34例。ALP组男21例,女13例;年龄20~63(35.16±8.45)岁;SandersⅡ型14例,SandersⅢ型20例;采用ALP内固定治疗。OSP组男20例,女14例;年龄19~63(35.05±8.39)岁;SandersⅡ型19例,SandersⅢ型15例;采用OSP内固定治疗。观察并比较两组患者手术时间、术中出血量及并发症情况,比较术前和术后6、12个月Bohler角、Gissane角的变化情况,并分别于术后6、12个月采用美国足踝外科协会(American Orthopaedic Foot&Ankle Society,AOFAS)踝与后足评分和伤残指数评分(foot and ankle disability index,FADI)评价手术疗效。结果:68例患者均获得随访,时间11~14(12.06±0.81)个月。两组手术时间、术中出血量、切口感染和再次骨折例数比较差异无统计学意义(P>0.05)。两组螺钉松动例数比较差异有统计学意义(P<0.05)。术后6、12个月ALP组Bohler角、Gissane角高于OSP组(P<0.05);且ALP组Bohler角、Gissane角改善幅度高于OSP组(P<0.05)。ALP组术后6、12个月AOFAS评分均高于OSP组(P<0.05),但两组AOFAS评级比较差异无统计学意义(P>0.05)。ALP组术后6、12个月FADI评分高于OSP组(P<0.05)。结论:与普通钢板相比,应用解剖锁定钢板治疗SandersⅡ、Ⅲ型跟骨骨折能取得更好的治疗效果,避免螺钉松动,减少并发症,更好地改善患肢功能。

Objective:To compare clinical efficacy between anatomical locking plate(ALP)and ordinary steel plate(OSP)in treating closed calcaneal fractures with SandersⅡandⅢ.Methods:From May 2016 to May 2018,68 patients with closed Sanders type Ⅱ and Ⅲ calcaneal fractures were retrospectively analyzed,and were divided into anatomical locking plate group(ALP group)and ordinary steel plate group(OSP group)according to two kinds of plate fixation,and 34 patients in each group.In ALP group,there were 21 males and 13 females aged from 20 to 63 years old with average of(35.16±8.45)years old;14 patients were type Ⅱ and 20 patients were type Ⅲ according to Sanders classification;treated with ALP.In OSP group,there were 20 males and 14 females aged from 19 to 63 years old with average of(35.05±8.39)years old;19 patients were type Ⅱ and 15 patients were type Ⅲ according to Sanders classification;treated with OSP.Operative time,intraoperative blood loss and complications between two groups were observed and compared;preoperative and postoperative Böhler angle and gissane angle were also compared;American Orthopaedic Foot&Ankle Society(AOFAS)ankle and hind foot scores,foot and ankle disability index(FADI)scores were applied to evaluate clinical effect.Results:All patients were followed up from 11 to 14 months with an average of(12.06±0.81)months.There were no statistical differences in opertive time,intraoperative blood loss,incision infection and refracture rate in complications between two groups(P>0.05);while there was significant difference in the number of screw loosening(P<0.05).Böhler angle and Gissane angle in ALP group at 6 and 12 months after opertaion were higher than that of OSP group(P<0.05),and the degree of improvement of Böhler angle and Gissane angle in ALP group were also higher than that of OSP group(P<0.05).Postopertaive AOFAS score and FADI score at 6 and 12 months in ALP group were higher than that of OSP group(P<0.05),while no statistical difference in AOFAS grading between two groups(P>0.05)Conclusion:Compared with OSP,ALP in treating Sanders Ⅱ and Ⅲ calcaneal fractures could achieve better therapeutic effect,avoid screw loosening,reduce complications,and improve limb function in further.