改良跟骨接骨板内固定联合植骨治疗跟骨关节内塌陷骨折的疗效观察

目的 探讨改良跟骨接骨板内固定联合植骨治疗跟骨关节内塌陷骨折的疗效.方法 选择80例（97足）患者,采用随机数字表法分为未植骨组和植骨组.未植骨组40例47足,采用改良跟骨接骨板内固定治疗.植骨组40例50足,采用改良跟骨接骨板内固定联合植骨治疗.结果 未植骨组并发症发生率25.0％,植骨组并发症发生率19.1％,两组并发症差异发生率无统计学意义（Х^2=0.21,P＞0.05）.两组术后Bhler＇s角和跟骨高度差异均有统计意义（t=14.50、16.99,均P＜0.05）.未植骨组Maryland功能优良率66.0％,植骨组为86.0％,植骨组优良率高于未植骨组（Х^2=5.38,P＜0.05）.两组完全负重时间差异有统计学意义（t=11.17,P＜0.05）.未植骨组术后1年的Bhler＇s角和远期Bhler＇s角丢失同植骨组差异均有统计学意义（t=29.76、9.81,均P＜0.05）.结论 改良接骨板内固定联合植骨治疗跟骨关节内塌陷骨折可以取得较好的疗效,可以避免远期复位丢失.

Observation of the effect of improved bone plate fixation and bone grafting in the treatment of intra-articular calcaneal fracture

Objective To investigate the effect of improved bone plate fixation and bone grafting in the treat ment of intra-articular calcaneal fracture.Methods 80 patients with intra-articular calcaneal fractures were randomly divided into the two groups.The non-bone graft group（47 feet in 40 patients）was given improved bone plate fixation.The bone graft group（50 feet in 40 patients）was given improved bone plate fixation and bone grafting.Results The incidence rate of complication in the non-bone graft group was 25.0% and that in the bone graft group was 19.1%.The difference between the two groups was not significant（Х^2 =0.21,P 〉 0.05）.Postoperative Bhler＇s angle and calcaneal height between the two groups had significant differences （t =14.5,16.99,all P 〈 0.05）.The excellent rate of Maryland functionality in non-bone graft group was 66.0%,which was significantly lower than 86.0% in the bone graft group（Х^2 =5.38,P 〈 0.05）.The average full weight bearing time between the two groups had significant difference （t =11.17,P 〈 0.05）.Bhler＇s angle after 1 year and forwa rd Bhler＇s angle loss of the non-bone graft group had significant differences compared with the bone graft group （t =29.76,9.81,all P 〈 0.05）.Conclusion Improved bone plate fixation and bone grafting in the treatment of intra-articular calcaneal fracture can obtain better results and avoid the long-term loss of reduction.