解剖锁定钢板与普通钢板内固定治疗跟骨骨折的临床疗效对比  

Anatomical locking plate versus unlocking conventional plate fixations in treatment of calcaneal fractures: a comparative study

作　　者：汤文杰[1] 王金辉[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中国矫形外科杂志》2016年第8期706-711,共6页Orthopedic Journal of China

摘　　要：[目的]探讨解剖锁定钢板与普通钢板治疗跟骨骨折的临床疗效差异。[方法]回顾性分析本科2008年7月~2013年7月收治的SandersⅡ~Ⅳ型跟骨骨折患者89例,男63例,女26例;平均年龄（34±9.1）岁（19~60岁）。根据治疗方式分为两组：解剖锁定钢板组及普通钢板组。收集病例资料包括一般资料和手术相关资料,其中一般资料包括年龄、性别、伴随基础疾病、受伤机制;手术相关资料包括术前和末次随访的影像学资料、手术时间、术中失血量、术后并发症、骨折愈合时间及伤足功能评分。伤足功能评分采用美国足踝外科协会（amerian orthopaedic foot＆ankle society,AOFAS）踝与后足评分系统。随访资料均通过门诊复查方式获得。对解剖锁定钢板组及非锁定钢板组患者的一般资料及手术相关资料进行对比分析。[结果]术后随访期间,所有患者均得到随访,随访时间1~3年,平均16个月。3例普通钢板患者出现螺钉松动,骨折关节面再移位。锁定钢板组未出现螺钉松动情况。切口相关并发症8例,非锁定钢板患者5例,锁定钢板患者3例,经换药对症治疗伤口均愈合。两组患者的年龄、性别、伴随基础疾病、手术时间、术中失血量、骨折愈合时间差异无统计学意义（P〉0.05）;末次随访时非锁定钢板组B？hler、Gissane角分别为（14.0±4.8）°、（109.0±4.9）°,锁定钢板组分别为（27.0±6.3）°、（129.0±9.1）°,两组间B？hler、Gissane角的差异有统计学意义（P〈0.05）锁定钢板组全足负重时间显著低于普通钢板组,差异有统计学意义（P〈0.05）。锁定钢板组患者术后B？hler、Gissane角高于普通钢板组,差异有统计学意义（P〈0.05）;锁定钢板组患者功能恢复情况显著高于普通钢板组（P〈0.05）。[结论]锁定钢板对改善患者术后功能有更优良的效果。在临床实际工作中,应当重视跟骨锁定钢板的作用。[Objective]To compare the result clinical efficacy of anatomical locking plates and unlocking conventional plate screws in the treatment of calcaneal fractures. [Method]A retrospective analysis was performed ion 89 patients with Sanders II- IV calcaneal fractures admitted to our hospital fromB etween July 2008 to July 2013,89 cases of calcaneal fracture were treated with open reduction and plate fixation（ Theose patients,consisting of 63 males and 26 63 cases; females 26 cases）,were aged from 19 to 60 years（ mean and were The average age was 34 ± 9. 1 yrs1 years） old on average.（ 19-60 yrs）. They could beT hose patientsey were divided into anatomical two groups： plates with locked screwslocking plate group and plated without locked screwsnon- locking plate group. The dT he datas ata collected from those patients included the general datas and datas associated with surgery. The general datas included age,sexgender,medical underlying disease,injury mechanism; Datas associated with surgery included,radiological data before surgery and at the final follow- uppreoperative and postoperative radiological data,duration of operation time,blood loss during operation,postoperative complications,union timetime to fracture healing,and functional scorescores for injured foot function. The ankle and hindfoot scoringrating system developed by the American Orthopaedic Foot ＆ Ankle Society was used to assess the function of injured foot. The injuried foot was assessed by the Amerian Orthopaedic Foot ＆ Ankle Society（ AOFAS）. The follow- up data was achieved byobtained by the outpatientreexamination in the clinic. Comparison of the general information and surgical data was performed between the two groups. We compared the effect of the locking plates and unlocking plates on the treatment of calcaneal fracture. [Result]During the follow- upperiod,screw loosening and articular surface displacement were found in 3 cases patients with non- locking plate fixation occurredscrew loose and articular surface displaceme

关 键 词：跟骨骨折 锁定钢板 非锁定钢板 

分 类 号：R687.3[医药卫生—骨科学]