解剖锁定钢板内固定结合植骨与不植骨治疗Sanders Ⅲ、Ⅳ型跟骨骨折的效果比较

朱康　马明　鲍启忠

【摘要】 目的：比較Sanders Ⅲ、Ⅳ型跟骨骨折患者应用解剖锁定钢板内固定结合植骨与不植骨治疗的临床效果。方法：回顾性分析2013年3月-2016年6月于本院骨科诊治57例Sander Ⅲ、Ⅳ型跟骨骨折患者的临床资料，按照不同手术方式分为对照组（28例）与植骨组（29例）。对照组行单纯切开解剖锁定钢板固定，植骨组行切开复位、解剖锁定钢板固定并取髂骨植骨治疗。比较对照组和植骨组手术前后各项指标，以及术后6个月和1年的随访情况。结果：植骨组手术时间明显长于对照组，差异有统计学意义（t=10.500，P<0.01）。两组骨折愈合时间比较，差异无统计学意义（t=0.371，P=0.712）。两组手术前后B?hler角、Gissane角及跟骨宽度比较，差异均有统计学意义（P<0.05）；但术后两组的B?hler角、Gissane角及跟骨宽度比较，差异均无统计学意义（t=0.150、0.849、0.706，P>0.05）。植骨组优良率为89.66%，与对照组的89.29%比较，差异无统计学意义（字2=0.002，P=0.964）。植骨组有6例明显取骨区不适，对照组因未取骨无不适，比较差异有统计学意义（字2=6.475，P=0.011）。植骨组全负重时间明显短于对照组（t=5.700，P<0.001）。两组术后1年感染率比较，差异无统计学意义（字2=0.316，P=0.574）。结论：经解剖锁定钢板固定结合植骨或不植骨治疗的Sanders Ⅲ、Ⅳ型跟骨骨折患者预后均良好，但不植骨的手术时间较短，无取骨后不适，因此单纯使用解剖锁定钢板固定治疗Sanders Ⅲ、Ⅳ型跟骨骨折更有优势。

【关键词】 跟骨骨折； 解剖锁定钢板； 植骨

Comparison of the Effects of Anatomically Locked Plate Internal Fixation Combined with Bone Graft and Non-graft for Sanders Ⅲ and Ⅳ Calcaneal Fractures/ZHU Kang，MA Ming，BAO Qizhong.//Medical Innovation of China，2018，15（14）：024-028

【Abstract】 Objective：To analyze the clinical effect of anatomical plate fixation whether ilium grafting in the treatment of Sanders Ⅲ，Ⅳ type calcaneus fracture.Method：The clinical data of 57 cases of Sander type Ⅲ，Ⅳ calcaneal fracture treated in orthopedics department of our hospital from March 2013 to June 2016 were retrospectively analyzed，they were divided into control group（28 cases）and bone graft group（29 cases）according to different operation methods.The control group was treat with anatomical plate fixation，the bone graft group was treated with anatomical plate fixation and ilium grafting.The indices at pre-operation，post-operation，and 1 year after operation were compared between the two groups.Result：The operation time in the bone graft group was longer than that in the control group（t=10.500，P<0.01）.There was no statistically significant in fracture healing time between the two groups（t=0.371，P=0.712）.Before and after operation，the Bhler angle of Gissane and the width of calcaneus were significantly different between the two groups（P<0.05）；however，there was no significant difference in Bhler angle and calcaneal width between the two groups after operation（t=0.150，0.849，0.706，P>0.05）.The excellent rate of bone graft group was 89.66%，compared with 89.29% in the control group，there was no significant difference（字2=0.002，P=0.964）.In the bone graft group，6 cases had obvious discomfort in the bone extraction area，while in the control group there was no discomfort due to no bone extraction，the difference was statistically significant（字2=6.475，P=0.011）.The time of weight loading in the bone graft group was shorter than that in the control group（t=5.700，P<0.001）.There was no statistically significant in infection rate 1 year after operation in the two groups（字2=0.316，P=0.574）.Conclusion：The prognosis of patients with Sanders Ⅲ and Ⅳ calcaneal fractures treated by anatomic locking plate fixation combined with or without bone graft was good，but the operation time without bone graft was shorter and there is no discomfort after bone extraction.Therefore，only anatomic locking plate fixation is used to treat Sanders Ⅲ and Ⅳ calcaneal fracture is more advantageous.

【Key words】 Calcaneus fracture； Anatomical locking plate； Bone graft

First-authors address：Beijing Changping Hospital of Traditional Chinese Medicine，Beijing 102200，China

doi：10.3969/j.issn.1674-4985.2018.14.006

跟骨骨折为最常见的跗骨骨折，约占全部跗骨骨折的60%，多为高处跌落足跟着地所致。切开复位内固定是治疗Sanders Ⅲ、Ⅳ型跟骨骨折的首选方法[1-2]。大多数的跟骨骨折常伴随一定程度的骨缺损，需对患者进行植骨手术加以修复。本研究回顾性分析了2013年3月-2016年6月于本院骨科诊治的57例Sanders Ⅲ、Ⅳ型跟骨骨折患者临床资料，现将结果报道如下。

1 资料与方法

1.1 一般资料 选取2013年3月-2016年6月于本院骨科诊治的Sander Ⅲ、Ⅳ型跟骨骨折患者57例的临床资料进行回顾性分析。纳入标准：（1）均为单侧闭合性骨折；（2）均符合跟骨骨折的诊断标准；（3）均有手术适应证；（4）均能够耐受治疗；（5）均签署知情同意书。排除标准：（1）合并严重肝肾疾病；……