小切口切开复位全螺纹空心螺钉与微创解剖锁定接骨板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的短期疗效比较  

Open reduction with small incision and full thread hollow screw versus minimally invasive locking plate for treatment of Sanders Ⅱ and Ⅲ calcaneal fractures

作　　者：张弛 金成龙 黄晓涛 谢长发 严帮吉 孙德麟 ZHANG Chi;JIN Chenglong;HUANG Xiaotao;XIE Changfa;YAN Bangji;SUN Delin(Department of Orthopedics and Traumatology,Cixi Hospital of Traditional Chinese Medicine,Cixi 315300,Zhejiang;Yantai Hospital of Shandong Wendeng Orthopedics&Trauma Tology,Yantai 264003,Shandong;Department of Orthopedics,Yantai Affiliated Hospital,Binzhou Medical College,Yantai 264100,Shandong,China)

机构地区：[1]慈溪市中医医院骨伤科,浙江慈溪315300 [2]山东文登整骨烟台医院,山东烟台264003 [3]滨州医学院烟台附属医院骨科,山东烟台264100

出　　处：《中华骨与关节外科杂志》2019年第10期796-799,804,共5页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金（81470054）

摘　　要：背景:跟骨骨折可能累及各关节面,治疗不当会造成畸形愈合,导致创伤性关节炎,具有较高致残率,严重影响患者的日常生活,常需要手术治疗。目的:比较小切口切开复位全螺纹空心螺钉与微创解剖锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法:选取2016年6月至2018年3月收治的SandersⅡ、Ⅲ型跟骨骨折患者82例,随机分为接骨板组和螺钉组,每组各41例。接骨板组采用微创解剖锁定接骨板固定,螺钉组采用全螺纹空心钉固定。比较两组患者手术时间、住院费用、骨折愈合时间、手术前后B?hler角和Gissane角,并采用Maryland评分系统对患者术后6个月的足部功能恢复情况进行评估。结果:所有患者均获得随访,随访时间8~15个月,平均(11.3±3.6)个月。两组患者手术时间比较有统计学差异(P<0.05),螺钉组明显短于接骨板组;住院费用和骨折愈合时间的差异无统计学意义(P>0.05)。两组患者术后B?hler角和Gissane角均较术前明显改善,差异有统计学意义(P<0.05),但两组间患者术后跟骨B?hler角和Gissane角比较,差异均无统计学意义(P>0.05)。螺钉组和接骨板组患者术后半年功能恢复优良率分别为80.5%、82.9%,差异无统计学意义(P>0.05)。结论:小切口切开复位全螺纹空心螺钉与微创解剖锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折均是治疗跟骨骨折的有效术式,短期疗效肯定,但全螺纹空心螺钉固定能明显缩短手术时间,减轻手术创伤,更有利于患者术后康复。Background: Calcaneal fracture may involve all articular surfaces, and improper treatment will result in malunion,traumatic arthritis and a high disability rate, which seriously affects the daily life of patients and often need surgical treatment.Objective: To compare the clinical effect of open reduction with small incision and full thread hollow screw and minimally invasive locking plate. Methods: Eighty-two patients with calcaneal fractures of SandersⅡand Ⅲ types treated from June 2016 to March 2018 were selected and divided into locking plate group(n=41) using minimally invasive locking plate and screw group(n=41) using full thread hollow screw. The time of operation, hospitalization expense, fracture healing time, B?hler’s angle and Gissane’s angle were compared between the two groups. The Maryland foot score system(MFS) was used to evaluate the function of foot at half of year after operation. Results: The patients in both groups were followed up for 8-15 months with the average of(11.3±3.6) months. The time of operation was shorter in the screw group than in the locking plate group(P<0.05). The hospitalization expense and the fracture healing time were not significantly different between the two groups(P>0.05). The B?hler’s angle and Gissane’s angle of the two groups were both significantly improved compared with those before operation, and the differences were not statistically significant between the two groups(P>0.05). The excellent and good rate of postoperative foot functional recovery was 82.9% and 80.5% in the locking plate group and screw group respectively and the difference was not statistically significant between the two groups. Conclusions: Both open reduction with small incision and full thread hollow screw and minimally invasive locking plate are effective for treatment of SandersⅡ and Ⅲ calcaneal fracture. However, open reduction with small incision and full thread hollow screw has the advantages of shorter operation time,less operative trauma and better recovery.

关 键 词：跟骨骨折 切开复位 内固定 接骨板 螺钉 

分 类 号：R687.3[医药卫生—骨科学]