微型锁定接骨板组合经皮螺钉内固定对跟骨SandersⅡ～Ⅲ型闭合骨折的疗效及机制  

Curative Effects and Mechanism of Mini-Locking Plate Combined with Percutaneous Screw Internal Fixation in the Treatment of Patients with Sanders Type Ⅱ～Ⅲ Calcaneus Closed Fracture

作　　者：孙勃[1] 刘士波[1] 王培[1] 薛鑫鑫[1] 高云峰[1] 付世杰[1] SUN Bo;LIU Shibo;WANG Pei;XUE Xinxin;GAO Yunfeng;FU Shijie(Hand and Foot Surgery,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China)

机构地区：[1]承德医学院附属医院手足外科

出　　处：《贵州医科大学学报》2019年第10期1205-1209,1214,共6页Journal of Guizhou Medical University

基　　金：河北省医学科学研究重点课题(20150017)

摘　　要：目的:探讨微型锁定接骨板组合经皮螺钉内固定对跟骨SandersⅡ~Ⅲ型闭合骨折的疗效及患者血清氧诱导因子1α(HIF-1α)、血管内皮生长因子(VEGF)表达的影响。方法:56例行微型锁定接骨板组合经皮螺钉内固定治疗的跟骨SandersⅡ~Ⅲ型闭合骨折患者作为实验组,54例行切开复位钢板内固定治疗跟骨SandersⅡ~Ⅲ型闭合骨折患者作为对照组;比较2组患者手术时间、切口愈合时间、住院总时间、术中出血量及术后并发症,观察2组患者术后6个月时的足功能恢复优良率;于治疗前及术后3个月时测量2组患者的跟骨长度、高度、宽度、Bhler角及Gissane角;于治疗前及术后3d时,采用酶联免疫吸附法检测2组患者血清HIF-1α及VEGF水平。结果:实验组患者手术时间长于对照组,切口愈合时间、住院总时间短于对照组,术中出血量少于对照组,术后并发症发生率(3.58%)低于对照组(14.81%),差异有统计学意义(P<0.01或P<0.05);术后6个月时,2组患者足功能恢复优良率比较,差异无统计学意义(P>0.05);实验组患者跟骨长度与高度大于对照组、跟骨宽度小于对照组,Bhler角、Gissane角大于对照组,差异有统计学意义(P<0.01);术后3d时,实验组患者血清HIF-1α、VEGF水平高于对照组,差异有统计学意义(P<0.01)。结论:微型锁定接骨板组合经皮螺钉内固定对跟骨SandersⅡ~Ⅲ型闭合骨折疗效优于常规手术治疗,其机制可能与HIF-1α、VEGF水平增高、术后骨折端血管新生有关。Objective:To explore effect of mini-locking plate combined with percutaneous screw internal fixation on expression of serum hypoxia inducible factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF)of patients with Sanders type II-III calcaneus closed fracture of and influences.Methods:Micro-locking plate combined with percutaneous screw internal fixation were performed on patients with Sanders type II-III calcaneus closed fracture were included into group experiment,while 54 Sanders type II-III calcaneus closed fracture patients received open reduction and plate internal fixation were included into control group.Comparing operation time,joint recovery time,total hospital stay time,blood loss amount during operation,post-operation complication;observing function recovery rate of both groups six month after surgery.Measuring length of calcaneus,height,width,Bhler angle and Gissane angle;before and three days after surgery,adopting ELISA assay to test serum HIF-1αand VEGF level.Results:The operation time of experiment group was longer than that of control group,while incision healing time and total hospitalization time were shorter than those of control group,the complication occurrence rate(3.58%)was lower than control group(14.81%),difference was statistically significant(P<0.01 or P<0.05).six months after treatment,foot function of both groups showed no statistical difference(P>0.05);the length of calcaneus and height of experiment group was bigger than that of control group,the width was smllar than control group;Bhler angle and Gissane angle in experiment group were larger than those in control group,differences were statistically significant(P<0.01);three days after treatment,levels of serum HIF-1αand VEGF in experiment group were higher than those in control group(P<0.01).Conclusion:The effect of mini-locking plate combined with percutaneous screw internal fixation on patients with Sanders type II-III calcaneus closed fracture was better than conventional treatment.The mechanism might be related to

关 键 词：跟骨 闭合骨折 微型锁定接骨板 经皮螺钉内固定 血清氧诱导因子1α 血管内皮生长因子 

分 类 号：R683.42[医药卫生—骨科学]