摘要
目的:探讨不植骨情况下单纯解剖锁定钢板内固定术治疗SandersⅢ、Ⅳ型跟骨骨折的效果。方法:回顾性分析60例SandersⅢ、Ⅳ型跟骨粉碎性骨折患者的临床资料,其中观察组32例患者行跟骨外侧手术入路、不植骨、切开复位解剖锁定钢板内固定治疗,对照组28例行跟骨外侧手术入路、自体髂骨植骨、切开复位内固定治疗,观察和记录两组患者术后相关并发症的发生情况,随访过程中定期复查X线片,测量和比较手术前后影像学B?hler角、Gissane角、跟骨高度和跟骨宽度的变化,采用Maryland足部功能评分系统综合评估和对比两组手术效果。结果:两组患者术后均获6~12个月(平均8个月)随访,组内所有病例术后均无钢板松动脱出、螺钉断裂等并发症发生。对照组2例患者出现切口渗出,皮缘坏死1例,均对症换药后愈合,组内所有患者术后7~11周(平均9周)X线片显示跟骨骨折获愈合,6个月组内均能行走;末次随访时与组内相比,两组B?hler角、Gissane角、跟骨高度及跟骨宽度与术前相比均获得明显改善,两组间上述指标对比则无显著性差异。末次随访时观察组平均Maryland足部功能评分(87.1±5.9)分,优23例,良6例,可3例,优良率90.6%。对照组平均Maryland足部功能评分(85.9±6.3)分,优19例,良5例,可4例,优良率85.7%。结论:不植骨情况下行单纯解剖锁定钢板内固定术治疗SandersⅢ、Ⅳ型跟骨骨折,固定稳定性良好,跟骨形态和足部功能恢复好,并发症少,有效避免了自体髂骨植骨内固定术后的切口感染及不愈合的发生。
Objective To explore the clinical effect of anatomic locking plate open reduction and internal fixation without bone graft for treatment of Sanders type Ⅲ and Ⅳ caleaneal fracture. Methods A retrospec- tive analysis of 60 patients with Sanders Ⅲ and Ⅳ type of calcaneal fracture was performed. Thirty-two patients in the observation group were treated with calcaneal lateral surgical approach and anatomic locking plate inter- nal fixation without bone graft. Twenty-eight cases in the control group were treated with lateral calcaneal ap- proach, autogenous iliac bone graft, open reduction and internal fixation. Postoperative observation and records of the occurrence of related complications were performed. During follow-up, X-ray was used, to measure and compare the imaging BShler angle, Gissane angle calcaneal width and height of calcaneus changes before and af- ter surgery. Postoperative surgical treatment effect was evaluted using Maryland foot function comprehensive as- sessment scoring system. Results Patients in two groups were follow-up from 6 to 12 months （average 8 months）. There was no plate loosened, screws fractured and other complication. The control group had 2 patients of incision effusion, 1 case of skin necrosis, which were symptomatic healed after dressing. X-ray showed cal- caned fractures in all patients were healed 7-11 weeks （average 9 weeks） after operation. All patients could walk 6 months after operation. Bohler angle, Gissane angle, height of calcaneus and calcaneal width in two groups at the last follow-up were significantly improved than preoperation. At the end of the follow-up, 32 patients in the observation group had an average Maryland foot score of （87.1 ± 5.9） points. The excellent rate in observation group was 90.6%. In the control group, the average Maryland foot function score was （85.9 ±6.3） points. The excellent rate was 85.7%. Conclusion Anatomic locking plate open reduction and internal fixation without bone graft for the treatment of Sanders type Ⅲ
出处
《中国中西医结合外科杂志》
CAS
2017年第5期491-495,共5页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
关键词
跟骨骨折
解剖复位
钢板
内固定术
植骨
Calcaneal fractures
anatomical reduction
locking plate
internal fixation
bone graft
