小切口微型锁定钢板与传统切口钢板内固定治疗跟骨关节内骨折的对照研究

目的：比较小切口微型锁定钢板内固定与传统L形切口钢板内固定治疗跟骨关节内骨折的临床疗效。方法对20例跟骨骨折患者采用小切口微型锁定钢板内固定术治疗（A组），其中SandersⅡ型14例，Ⅲ型4例，Ⅳ型2例；18例跟骨骨折患者采用传统L形切口手术入路钢板内固定术治疗（B组），其中SandersⅡ型9例，Ⅲ型6例，Ⅳ型3例。统计并比较两组患者手术时间、切口长度、住院天数、术后第1天的VAS评分、术后切口愈合情况、植骨例数、出血量、术后末次随访时影像学检查及术后半年的足部功能按美国足踝外科协会（AOFAS）踝后足评分评定]。结果所有患者均获6～15个月（平均10.3个月）随访，A组患者手术时间、切口长度、住院天数及VSA评分均少于B组，切口甲级愈合所占的比例大于B组，差异均有统计学意义（P＜0.05或0.01）；两组植骨例数、术后影像学检查所见及AOFAS踝后足评分的差异均无统计学意义（均P＞0.05）。结论对SandersⅡ型及部分Ⅲ型跟骨骨折患者，采用小切口微型锁定钢板内固定治疗，具有手术切口小、创伤小、手术时间短、住院时间短、切口并发症少、疗效确切等优点。

Comparison of small incision mini locking plate fixation with traditional incision plate internal fixation in treatment of intra-articular calcaneal fracture

Objective To compare smal incision mini locking plate fixation with traditional incision plate internal fixation in treatment of intra- articular calcaneal fracture. Methods Thirty eight patients with intra- articular calcaneal fracture were treated with two different approaches. Twenty patients received smal incision mini locking plate fixation （group A）, including 14 cases with type II, 4 type III and 2 type IV according to Sanders classification;18 patients received traditional L shaped incision plate fixation（group B）, including 9 cases with type II, 6 type III and 3 type IV. The operation time, incision length, length of hospital stay, VAS score at d1 after operation, postoperative wound healing, cases of bone graft, bleeding volume, CT findings at last fol ow- up and foot function at 6 month after operation evaluated by USA Ankle Surgery Association （AOFAS） ankle hindfoot score were compared between two groups. Results Patients were fol owed up for average 10.3m （6-15m）. The operation time, incision length, wound complications and VSA pain scores at postoperative d1 in group A were al less than those in group B （P〈0.05 or 0.01）;meanwhile there were no significant differences in number of cases of bone grafting, postoperative CT findings and AOFAS ankle hindfoot scores between two groups （P〉0.05）. Conclusion Compared to traditional L shaped operation posterior internal fixation, the smal incision and mini locking plate fixation has smal er incision, less trauma, shorter operation time, shorter length of hospital stay, less incision complications and better curative effect for patients with calcaneal fractures.