锁定接骨板结合重组人骨形态发生蛋白骨修复材料治疗跟骨骨折的临床分析

目的 探讨锁定接骨板结合重组人骨形态发生蛋白(rhBMP)骨修复材料植入治疗跟骨骨折临床疗效.方法 回顾性研究2013年12月-2015年12月期间行切开复位锁定接骨板内固定结合rhBMP骨修复材料植入治疗的SandersⅢ、Ⅳ型跟骨骨折患者15例,采用外侧"L"型切口,术中复位跟骨后关节面,恢复跟骨高度及宽度,在骨缺损处用1~2 mg的rhBMP骨修复材料填塞,比较术前、术后及末次随访时B?hler角、Gissane角变化,Maryland足部评分系统评估足部功能.结果 患者术后无切口不愈合及感染,骨折均愈合并均获随访,随访时间12~24个月,平均(16.57 ±2.42)个月,术后半年均能正常行走.术后B?hler角(35.8 ±1.75)°和Gissane角(132.9 ±2.85)°改变较术前B?hler角(3.62 ±1.00)°和Gissane角(159.3 ±3.65)°差异有统计学差异(P<0.05),且末次随访时B?hler角(35.2 ±0.92)°和Gissane角(132.4 ±2.41)°无明显改变(P>0.05),Mary-land足部评分系统评价:优10例,良4例,可1例,优良率93.3%.结论 锁定接骨板结合rhBMP骨修复材料治疗SandersⅢ、Ⅳ型跟骨骨折可有效维持跟骨解剖形态,促进骨愈合,获得满意疗效.

The treatment of calcaneal fractures using locking plate combined with rhBMP implantation

Objective To explore the effect of the treatment of calcaneal fractures with locking plate and rhBMP implantation.Methods From December 2013 to December 2015,15 patients with Sanders type Ⅲ,Ⅳcalcaneal fractures were treated with open reduction and locking plate fixation combined with rhBMP implantation.The"L"lateral approach was used.After restoring the posterior articular sur-face and the height and width of the calcaneus,1-2 mg rhBMP bone repair material was filled in the bone defect.B?hler angles and Gis-sane angles at the time of preoperative,postoperative and follow-up were compared respectively.The foot functions were assessed at the last follow-up using Maryland scoring system.Results All patients were followed up in 12-24 months,average(16.57 ±2.42) months.There was no incision disunion and infection and all the fractures healed.All patients were able to walk free six months after surgery.Compared with preoperative,B?hler angles(35.8 ±1.75)°and Gissane angles(132.9 ±2.85)°after operation have changed with significant differences(P<0.05),and the angles remained unchanged at the last follow-up(P>0.05).According to Maryland foot score system,there were10 cases in excellent,4 cases in good,1 case in betterand the good rate was 93.3%.Conclusions The method of using locking plate combined with rhBMP implantation can effectively maintain the anatomical shape of calcaneus,improve the bone union and the postoperative efficacy is satisfactory.