CAJ | 학술논문

目的比较普通解剖钢板加自体髂骨植骨与锁定钢板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效. 方法对2010年8月至2013年l2月收治的68例Sanders Ⅱ、Ⅲ型跟骨骨折患者资料进行回顾性研究,根据治疗方式不同分为普通解剖钢板加自体髂骨植骨组(植骨组,36例)和锁定钢板组(非植骨组,32例).两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.记录并比较两组患者手术时间、术后引流量、住院时间、非负重下地时间、完全负重时间、并发症发生率、B(o)hler角、Gissane角、跟骨长度、宽度、高度及Maryland足功能评分优良率. 结果所有患者术后骨折愈合良好,均未出现术后感染、皮肤坏死及伤口不愈合.发生跟痛症状和跟腓撞击综合征的发生率比较差异均无统计学意义(P＞ 0.05).与非植骨组比较,植骨组的手术时间、住院时间、术后非负重下地时间都更长,差异均有统计学意义(P＜0.05);两组的术后引流量、完全负重时间差异无统计学意义(P＞0.05).所有患者术后1年的B(o)hler角、Gissane角,跟骨长度、宽度、高度与术前比较差异均有统计学意义(P＞0.05),但两组之间比较差异均无统计学意义(P＞ 0.05).两组Maryland足部评分优良率比较差异无统计学意义(P＞0.05). 结论采用锁定钢板不植骨相比采用普通钢板加自体髂骨植骨在复位效果及优良率方面无明显差异,考虑到采用锁定钢板不植骨为治疗方式避免了髂骨取骨区术后疼痛、感染、血肿以及患者不适感等并发症,在治疗SandersⅡ、Ⅲ型跟骨骨折方面具有一定优势.
목적 비교보통해부강판가자체가골식골여쇄정강판치료Sanders Ⅱ、Ⅲ형근골골절적료효. 방법 대2010년8월지2013년l2월수치적68례Sanders Ⅱ、Ⅲ형근골골절환자자료진행회고성연구,근거치료방식불동분위보통해부강판가자체가골식골조(식골조,36례)화쇄정강판조(비식골조,32례).량조환자술전일반자료비교차이균무통계학의의(P＞0.05),구유가비성.기록병비교량조환자수술시간、술후인류량、주원시간、비부중하지시간、완전부중시간、병발증발생솔、B(o)hler각、Gissane각、근골장도、관도、고도급Maryland족공능평분우량솔. 결과 소유환자술후골절유합량호,균미출현술후감염、피부배사급상구불유합.발생근통증상화근비당격종합정적발생솔비교차이균무통계학의의(P＞ 0.05).여비식골조비교,식골조적수술시간、주원시간、술후비부중하지시간도경장,차이균유통계학의의(P＜0.05);량조적술후인류량、완전부중시간차이무통계학의의(P＞0.05).소유환자술후1년적B(o)hler각、Gissane각,근골장도、관도、고도여술전비교차이균유통계학의의(P＞0.05),단량조지간비교차이균무통계학의의(P＞ 0.05).량조Maryland족부평분우량솔비교차이무통계학의의(P＞0.05). 결론 채용쇄정강판불식골상비채용보통강판가자체가골식골재복위효과급우량솔방면무명현차이,고필도채용쇄정강판불식골위치료방식피면료가골취골구술후동통、감염、혈종이급환자불괄감등병발증,재치료SandersⅡ、Ⅲ형근골골절방면구유일정우세.
Objective To compare the clinical efficacy between calcaneal anatomic plate + autologous bone graft and calcaneal locking plate in treatment of calcaneal fractures of Sanders types Ⅱ & Ⅲ.Methods The current study recruited 68 cases of calcaneal fractures of Sanders types Ⅱ &Ⅲ who had been treated in our hospital from August 2010 to December 2013.The patients were treated either by ordinary calcaneal anatomic plate plus autologous iliac bone graft (36 cases) or by calcaneal locking plate (32 cases).The general clinical data were compatible between the 2 groups (P ＜ 0.05).The 2 groups were compared in terms of operation time,postoperative drainage,hospital stay,non-bearing ambulant time,full bearing time,postoperative complications,B（o）hler angle,Gissane angle,the length,width and height of the calcaneus,and the Maryland scores of the foot function.Results All the patients achieved fine fracture union without postoperative infection,skin necrosis or wound dehiscence.There was no significant difference between the 2 groups in incidences of postoperative calcaneal pain or calcaneofibular impingement syndrome (P ＞ 0.05).The bone graft group needed significantly longer operation time,non-bearing ambulant time and hospital stay than the locking plate group (P ＜ 0.05).There were no significant differences between the 2 groups in postoperative drainage or full bearing time (P ＞ 0.05).There were significant differences between pre-operation and one year post-operation in B(o)hler angle,Gissane angle,and the length,width and height of the calcaneus (P ＜ 0.05),but not between the 2 groups (P ＞ 0.05).The 2 groups showed insignificant differences in the Maryland scores of the foot function either (P ＞ 0.05).Conclusion In treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ,compared with ordinary plate + autologous bone graft,locking plate without bone graft may reduce the incidences of post-operative pain caused by iliac bone graft,infection,hematoma,and other complications but shows no obvious advantages in calcaneal reduction or foot function.