钢板螺钉结合斯氏针内固定修复粉碎性跟骨关节内伴后上方骨折

背景：目前跟骨关节内粉碎性骨折的治疗方案一般选择钢板螺钉内固定，但对于伴有跟骨后上方骨折的病例，往往因为跟腱牵拉及钢板螺钉内固定的薄弱导致骨折复位困难或者复位难以保持。目的：探讨切开复位钢板螺钉结合斯氏针置入内固定在粉碎性跟骨关节内移位骨折伴后上方骨折中的疗效。方法：选取2009年12月至2013年12月上海中冶医院骨科收治的粉碎性跟骨关节内骨折伴跟骨后上方骨折患者40例，随机分为2组。对照组予切开复位钢板螺钉内固定，试验组予切开复位钢板螺钉结合斯氏针内固定。分别于术前、术后4周测量患者GISSANE角、BOHLER角，末次随访时进行MARYLAND足部评分，并进行组内及组间比较。结果与结论：所有患者均获随访，时间9-23个月。两组患者术后4周BOHLER角、GISSANE角均显著大于术前（P 〈0.05）；术后4周试验组BOHLER角、GISSANE角均显著大于对照组（P 〈0.05）。末次随访时MARYLAND足部评分试验组平均78分，优良率为80%；对照组平均67分，优良率为73%，试验组优良率显著高于对照组（P〈0.05）。提示钢板螺钉内固定辅助斯氏针置入固定修复粉碎性跟骨骨折伴有跟骨后上方骨折，可较单纯钢板螺钉置入内固定取得更为满意的关节内骨折及后上方骨折复位，固定牢靠，可早期功能锻炼，术后患肢功能恢复较单纯钢板螺钉内固定较好。

Combination of plate screw and Steinmann pin in repair of comminuted calcaneal intra-articular and posterosuperior fractures

BACKGROUND：The therapeutic regimen of intraarticular calcaneal comminuted fractures commonly selects plate and screw fixation. However, for case of posterosuperior calcaneal fracture, the weakness of achil es tendon stretch and plate screw fixation results in difficulty or maintenance of reduction. OBJECTIVE：To investigate the therapeutic effects of open reduction and internal fixation with steel screw and Steinmann pins for comminuted calcaneal intra-articular and posterosuperior fractures. METHODS：From December 2009 to December 2013, forty patients with fractures of comminuted calcaneal posterosuperior fractures were randomly divided into two groups. In the control group, patients were treated by open reduction and internal fixation by plate screw only. In the experimental group, patients were treated by open reduction and internal fixation by combination of plate screw and Steinmann pin. The Gissane and Bohler angles of the calcaneus were measured from lateral radiograph before and 4 weeks after surgery, and the MARYLAND score was assessed at the last fol ow-up. Gissane and Bohler angle and MARYLAND score were compared in each group and among different groups. RESULTS AND CONCLUSION：Al patients were fol owed up for 9-23 months. BOHLER and GISSANE angles were significantly bigger at 4 weeks after surgery compared with pre-treatment in both groups （P〈0.05）. BOHLER and GISSANE angles were significantly bigger in the experimental group than in the control group at 4 weeks after surgery （P〈0.05）. During final fol ow-up, the average score by MARYLAND Foot Score was 78 in the experimental group and 67 in control group, with their excellent and good rate of 80%and 73%. The excellent and good rate was significantly higher in the experimental group than in the control group （P〈0.05）. These data indicated that open reduction and internal fixation with combination of plate screw and Steinmann pin has better efficacy in treatment of the comminuted calcaneal intra-articular and posterosuperior fr