跟骨关节内骨折选择不同类型钢板内固定治疗临床研究

目的 比较跟骨锁定钢板和普通解剖钢板治疗跟骨关节内骨折的疗效。 方法 回顾性分析2010年1月~2013年4月收治跟骨关节内骨折患者中的34例(40足),分成锁定板组(18例20足)和解剖班板组(16例20足),采用跟骨锁定钢板和普通解剖钢板内固定治疗,分析两种内固定手术的围术期指标(手术时间、术中出血量、切口长度及住院时间),手术前后跟骨Bohler角及Gissane角距下关节面的移位的恢复情况,并发症及术后1年Maryland评分情况。 结果 两种钢板内固定手术围术期指标和并发症对比,差异无统计学意义(P>0.05);锁定板组及普通板组术后的跟骨长度、跟骨高度、跟骨宽度、Bohler角、Gissane角及距下关节面的移位的恢复均优于术前(P<0.05或P<0.01),患者采用锁定钢板的术后跟骨高度,Bohler角、Gissane角大于普通解剖钢板(P<0.05或P<0.01),距下关节面的移位小于普通解剖钢板(P<0.01);采用锁定钢板术后1年的Maryland评分高于普通解剖钢板(P<0.05),且累积优良率高于普通解剖型钢板(P<0.05),术后1年的轻度受限情况优于普通解剖型钢板(P<0.05)。 结论 内固定治疗跟骨关节内骨折,锁定板效果优于解剖型钢板。

A Clinical Study of Internal Fixation with Different Plate in the Treatment of Calcaneal Intra-articular Fractures

Objective Comparison of the therapeutic effects of calcaneal locking plate and ordinary anatomic plate in treatment of calcaneal intra-articular fractures. Methods From 2010 January to 2013 April,34 patients(40 feets) with intra-articular calcaneal fractures were chosen in our hospital, each patients received calcaneal locking plate or ordinary anatomical plate fixation, then compared the differences between the two kinds of internal fixation operation on the perioperative indicators (including operation time, blood loss, length of incision and hospital stays),the recovery of displaced subtalar joints, calcaneal Bohler angle and Gissane angle before and after the operation, and operative complications. Results There are no statistical differences (P>0.05) on the perioperative indicators and complications between the two kinds of internal fixation operation groups; In the locking plate group, after the operation, the length, height width of calcaneus and the recovery of displaced Bohler angle, Gissane angle and subtalar joints got better (P<0.05 or P<0.01), patients who received locking plate had greater calcaneal height, Bohler angle and Gissane angle than normal anatomical plate (P<0.05 or P<0.01), the displacement of subtalar articular surface is smaller than the normal anatomical plate (P<0.01). The Maryland scores of the patients in locking plate group 1 years after the operation were higher than that of normal anatomical plate group(P<0.05), and the cumulative excellent and good rate was higher than that of normal anatomical plate group(P<0.05),the mild limitation 1 years after the operation is also better than the normal anatomical plate group (P<0.05). Conclusion Locking plate is better than anatomical plate in internal fixation for treatment of intra-articular calcaneal fractures.