CAJ | 학술논문

目的：探讨锁定钢板结合同种异体骨植骨治疗SandersⅡ型、SandersⅢ型跟骨骨折的临床疗效。方法选择2011－06～2013－06间采用锁定钢板结合同种异体骨植骨治疗的50例SandersⅡ型、SandersⅢ型跟骨骨折患者，其中SandersⅡ型组25例， SandersⅢ型组25例，比较两组临床疗效。结果所有患者均获随访，时间12～18个月，平均（14.34±2.82）个月。 SandersⅡ型组术后bohler角（33.46°±4.22°），Gissane角（114.26°±3.83°）；SandersⅢ型组术后bohler角（32.14°±3.85°），Gissane角（122.58°±4.32°），两组bohler角、Gissane角与术前比较均有明显改善（ P＜0.05）。 SandersⅡ型组术后皮缘坏死或愈合不良1例，骨折愈合时间（11.6±3.5）周，术后Maryland评分优18例、良5例、可2例，优良率92％；SandersⅢ型术后皮缘坏死或愈合不良2例，骨折愈合时间（12.1±3.2）周，术后Maryland评分优14例、良8例、可3例，优良率88％，两组术后切口不良、愈合时间及优良率比较，差异无统计学意义（ P＞0.05）。结论锁定钢板结合同种异体骨植骨治疗SandersⅡ型、SandersⅢ型跟骨骨折临床疗效相似，关键在于解剖复位、合理植骨、坚强固定。
목적：탐토쇄정강판결합동충이체골식골치료SandersⅡ형、SandersⅢ형근골골절적림상료효。방법선택2011－06～2013－06간채용쇄정강판결합동충이체골식골치료적50례SandersⅡ형、SandersⅢ형근골골절환자，기중SandersⅡ형조25례， SandersⅢ형조25례，비교량조림상료효。결과소유환자균획수방，시간12～18개월，평균（14.34±2.82）개월。 SandersⅡ형조술후bohler각（33.46°±4.22°），Gissane각（114.26°±3.83°）；SandersⅢ형조술후bohler각（32.14°±3.85°），Gissane각（122.58°±4.32°），량조bohler각、Gissane각여술전비교균유명현개선（ P＜0.05）。 SandersⅡ형조술후피연배사혹유합불량1례，골절유합시간（11.6±3.5）주，술후Maryland평분우18례、량5례、가2례，우량솔92％；SandersⅢ형술후피연배사혹유합불량2례，골절유합시간（12.1±3.2）주，술후Maryland평분우14례、량8례、가3례，우량솔88％，량조술후절구불량、유합시간급우량솔비교，차이무통계학의의（ P＞0.05）。결론쇄정강판결합동충이체골식골치료SandersⅡ형、SandersⅢ형근골골절림상료효상사，관건재우해부복위、합리식골、견강고정。
Objective To analyze clinical effects of locking plates fixation combined with allograft for the treatment of Sanders type ⅡandⅢcalcaneal fractures.Methods From June, 2011 to June, 2013,50 patients with Sanders type Ⅱand Ⅲ calcaneal fractures were treated with locked plate fixation combined with allograft.There were 25 patients in Sanders typeⅡgroup.The clinical effects of two groups were compared.Results All cases had been followed up for 12~18 months, with an average of (14.34 ±2.82)months.Sanders typeⅡgroup had an average bohler angle of (33.46°±4.22°) and an average Gissane angle of (114.26°±3.83°) after surgery;Sanders typeⅢgroup had an average bohler angle of (32.14°±3.85°) and an average Gissane angle of (122.58°±4.32°) after surgery;the postopera-tive bohler angle and Gissane angle of two groups were improved significantly compared with preoperative bohler angle and Gissane angle ( P<0.05).Sanders typeⅡgroup had poor healing in 1 case, with an average fracture healing time of (11.6 ±3.5 ) weeks and Maryland good rate of 92%;Sanders type Ⅲgroup had poor healing in 2 cases, with an average fracture healing time of (12.1 ±3.2 ) weeks;and Maryland good rate was 88%, including 14 excellent cases , 8 relatively good cases , and 3 normal cases.In two groups of postoperative in-cision, healing time and was compared.There was no statistically significant difference of postoperative incision , healing time and Maryland good rate between two groups ( P >0.05 ).Conclusion Locking plate combined with allograft for the treatment of Sanders type ⅡandⅢcalcaneal fractures has the similar clinical curative effects.The key is anatomical repositioning , reasonable bone graft and strong fixation.