可塑性钛钢板置入治疗有移位的跟骨关节内骨折  

Treatment of displaced intra-articular fracture of calcaneus using plastic titanic plates

作　　者：付昌马[1] 杨祖华[1] 钱春生[1] 周思启[1] 章有才[1] 

机构地区：[1]合肥市第三人民医院骨科,安徽省合肥市230022

出　　处：《中国组织工程研究与临床康复》2011年第9期1686-1689,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:切开复位金属植入物置入内固定的方法和内固定材料很多,如特异性钢板、"U"型或者4脚钉直接固定、张力带固定等。由于跟骨形态复杂,切开复位必须是解剖复位及坚强的内固定,那么选择什么样的内固定材料方可避免远期并发创伤性关节炎和行走疼痛等症状呢?目的:探讨可塑性钛钢板在治疗有移位跟骨关节内骨折的临床应用价值及生物相容性。方法:纳入对30例(34足)SandersⅡ～Ⅳ型跟骨骨折患者,采用外侧L型及斜型切口入路、开放复位,置入可塑性钛钢板内固定,全部患者均自体髂骨植骨。X射线片评估钢板置入后疗效,按照Maryland足部功能评分,综合观察患者对疼痛主观感觉、功能恢复、运动情况等方面,同时观察两种切口能否一期愈合。结果与结论:30例中26例获得随访,时间为9～18个月,与内固定置入前相比,跟骨Bohler、Gissane角均得到很好的恢复(P<0.001)。按照Maryland足部功能评分,优良率为88.5%,并且外侧斜型切口具备良好的优势。提示可塑性钛钢板是治疗有移位跟骨关节内骨折的可靠方法,内固定前充分有效的准备和医生对跟骨的解剖熟悉以及内固定技巧和时机的掌握是手术成功的关键。BACKGROUND：There are various open reduction internal fixation methods and materials,such as specific plate,type U fixation,quadruple-feet nails or tension band fixation.Due to the complex anatomic structures of calcaneus,how to select an internal material that both has good internal strength and can avoid long-term complications need to be explored.OBJECTIVE：To evaluate the clinical value of plastic titanic plate for intra-articular fracture of calcaneus and its biocompatibility.METHODS：Plastic titanic plates were used in 30 cases （34 feet） with Sanders classificationⅡ-Ⅳ calcaneal fractures approached via lateral L and oblique incision.Autogenous iliac bone-grafting was used in all cases.Postoperative therapeutic effects were evaluated by X-ray film.Based on Maryland foot score,subjective pain assessment,functional recovery,and motion situations were observed.The healing conditions in two groups were compared.RESULTS AND CONCLUSION：Totally 26 cases were followed up for 9-18 months,compared with the preoperative group,Bohler angle and Gissane angle were significantly satisfactorily after operation （P0.001）.According to Maryland foot scores,the excellent and good rate was 88.5%,and the oblique lateral incision can be considered as a good alterative of lateral approach for intra-articular fracture of calcaneus.The open reduction and internal fixation with plastic titanic plate is reliable to treat displaced intra-articular fracture of calcaneus.Effective preparation before operation,surgery familiarity of fracture of calcaneus and basic anatomic of calcaneus are the key factors of successful operation.

关 键 词：跟骨骨折 关节内骨折 可塑性钛钢板 内固定 植入 

分 类 号：R318[医药卫生—生物医学工程]