摘要
目的探讨切开复位内固定（ORIF）、切开复位内固定联合自体骨植入融合、切开复位内固定联合同种异体骨植入融合术治疗SandersⅢ~Ⅳ型跟骨骨折的的疗效。方法随机抽取2009年1月至2013年6月收治的136例SandersⅢ~Ⅳ型跟骨骨折患者作为研究对象,按照手术方式不同分为三组,分别为ORIF组（A组,n=51例）、ORIF加自体骨植入组（B组,n=45）及ORIF加同种异体骨植入组（C组,n=40例）。比较三组患者的手术情况、骨折愈合情况、AOFAS评分情况及Bohler及Gissane角变化情况。结果三组患者的骨折愈合时间、随访时间相比较无统计学差异（P〉0.05）;B组患者的术中失血量显著高于A、C两组,A、C、B三组患者的手术时间依次增加,两两比较差异均有显著性（P〈0.05）;SandersⅢ型患者术后半年及术后1年的A、B、C三组AOFAS评分比较无统计学差异（P〉0.05）;术后半年及术后1年B、C组患者SandersⅣ型的AOFAS评分均显著高于A组患者（P〈0.05）;术后半年三组SandersⅢ型患者的Bohler角及Gissane角比较无统计学差异（P〉0.05）,而A组SandersⅣ型患者的Bohler角及Gissane角均显著低于B、C两组（P〈0.05）。结论 SandersⅢ型患者采用切开复位内固定无论是否植骨融合疗效均较为满意,可有效恢复患者的足踝关节功能;但对于SandersⅣ型患者由于后关节面波及严重,单独的采用ORIF手术无法完全解剖复位,疗效较差,建议采用切开复位内固定联合自体骨植入或切开复位内固定联合同种异体骨植入融合手术治疗。
Objective To explore the open reduction and internal fixation（ ORIF）,ORIF combined with autologous bone graft fusion,ORIF combined with allogeneic bone implants fusion treat for Sanders Ⅲ ~ Ⅳ calcaneal fracture. Methods Randomly selected 136 cases with Sanders Ⅲ ~ Ⅳ calcaneal fracture patients from January 2009 to June 2013 in our hospital. All these cases were considered as research subjects.According to the surgical procedure,these cases were divided into three groups,namely the ORIF group（ A,n = 51 cases）,ORIF combined with autogenous bone graft（ group B,n = 45） and ORIF combined with allogeneic bone implant group（ group C,n = 40 patients）. The surgical cases,fracture healing,AOFAS score,Gissane conditions and Bohler angle changes were compared. Results The healing time,followed- up time were compared,no statistically significant difference（ P〈0. 05）. The intraoperative blood loss in the group B was significantly higher the group A and group C. The operative time in the group A,C,B were increase with turn,there were significantly differences between any two groups（ P〉0.05）. The AOFAS score of Sanders Ⅲ type after six months and a year in the group A,B,C were no significantly difference（ P〉0. 05）. And The AOFAS score of Sanders Ⅳ type AOFAS score after six months and a year in the group B,C were significantly higher than group A（ P〈0.05）. The Bohler and Gissane angle of Sanders Ⅲ type after six months in the group A,B,C were no significantly difference（ P〉0. 05）,and the Bohler and Gissane angle of Sanders Ⅳ type after six months in the group A were significantly lower than group B、C. Conclusion Sanders Ⅲtype patients treated with open reduction and internal fixation,whether fusion or not. The efficacy are more satisfied,that can effectively restore joint function with bare feet. But for Sanders Ⅳ patients ORIF surgery could not fully reset to normal due to severely articular surface. It always with poorer treatment outcomes. We recommend open r
出处
《临床和实验医学杂志》
2016年第2期143-146,共4页
Journal of Clinical and Experimental Medicine
关键词
跟骨骨折
切开复位内固定
自体骨植入
同种异体骨植入
Calcaneal fractures
Open reduction and internal fixation
Autologous bone graft
Allogeneic bone graft
