跟骨关节内骨折内固定术中植骨与不植骨的中远期疗效比较(1)
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[摘要] 目的 探讨行切开复位内固定术植骨或不植骨在治疗跟骨关节内骨折患者中的临床价值。 方法 收集2003年4月~2008年8月于我院采用切开复位钢板内固定加植骨术(植骨组)或切开复位钢板内固定术(未植骨组)治疗跟骨关节内骨折资料完整的46例患者进行回顾性分析。对术后两组Maryland评分进行比较，并对术后跟骨外形恢复进行观察及功能评分。 结果 植骨组术后Maryland评分为(88.32±1.73)分，未植骨组为(81.43±1.99)分，两组比较差异无统计学意义(P > 0.05)。跟骨外形比较：术后1个月对两组骨折患者进行跟骨高度、宽度、Gissane角、Bohler角4项指标比较，两组差异无统计学意义(P > 0.05)。术后3个月及2年两组跟骨高度、Bolher角比较差异显著(P < 0.05)；跟骨宽度及Gissane角比较差异无统计学意义(P > 0.05)。结论 切开复位内固定术植骨治疗跟骨关节内骨折疗效好，较未植骨治疗其对骨外形恢复具有显著效果。
[关键词] 跟骨；植骨；疗效
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[中图分类号] R683.42[文献标识码] A[文章编号] 1673-7210(2012)03(c)-0068-03
Comparison of medium and long term curative effects of intra-articular calcaneal fracture internal fixation with or without bone graft
LI YanweiYAO JianfeiLIAN Kejian
Orthopaedic Hospital, 175th Hospital of People's Liberation Army, Fujian Province, Zhangzhou 366000, China
[Abstract] Objective To explore the clinical value of open reduction internal fixation with or without bone graft in the treatment of patients with intra-articular calcaneal fracture. Methods 46 patients receiving open reduction steel plate internal fixation with bone graft (bone graft group) or open reduction steel plate internal fixation without bone graft (none bone graft group) in the treatment of intra-articular calcaneal fracture from April 2003 to August 2008 were analyzed retrospectively. The postoperative Maryland scores of the two groups were compared. The postoperative appearance recovery of calcaneus were observed and evaluated. Results The Maryland scores were (88.32±1.73) points of the bone graft group and (81.43±1.99) points of the none bone graft group, the difference was not statistically significant (P > 0.05). Comparison of calcaneal appearance: one month after operation in patients with bone fracture showed that four indicators including calcaneal height, calcaneal width, Gissane angle and Bohler angle of the two groups had no significantly differences (P > 0.05). Three months and two year after the operation, the calcaneal height and Bolher angle were significantly different between the two groups (P < 0.05); the calcaneal width and Gissane angle had no significant different (P > 0.05). Conclusion The effect of open reduction internal fixation with bone graft in the treatment of patients with intra-articular calcaneal fracture is good, especially in the recovery of calcaneal appearance.
, 百拇医药
[Key words] Calcaneus; Bone graft; Curative effect
75%~85%的跟骨骨折常可波及跟距关节，是一种比较严重而复杂的创伤，且情况多样导致患者治疗困难，同时患者预后情况难以预判，致残率较高，不能得到满意治疗效果。患者出现跟骨骨折以后，受到垂直应力作用，距下关节面外侧的移位部分会被垂直应力压入跟骨体部的中央三角区，在跟骨形态恢复后的同时往往出现中央三角区的骨质缺损。尽管切开复位内固定手术治疗已被广泛应用于移位跟骨关节内骨折治疗，但对于术中是否需要植骨尚无定论，因此，本文就该问题进行了研究，现报道如下：
1 资料与方法
1.1 一般资料
选择2003年4月~2008年8月于我院进行治疗的跟骨关节内骨折患者46例，将其分为两组：植骨组22例，其中，男13例，女9例；平均年龄(37.1±11.6)岁；SandersⅡ型6例，SandersⅢ型10例，SandersⅣ型6例；未植骨组24例，其中，男15例，女9例；平均年龄(40.1±12.4)岁；SandersⅡ型8例，SandersⅢ型14例，SandersⅣ型2例。两组一般情况比较，差异无统计学意义(P > 0.05)，具有可比性。
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1.2 手术方法
未植骨组：采用持续硬膜外麻醉，对双侧骨折和单侧跟骨骨折分别取仰卧位和侧卧位，止血带充气至50~60 kPa。按足跟外侧扩大“L”形切口，自皮肤一刀至跟骨表面，继续用锐刀紧贴跟骨外侧壁将近端皮瓣向上剥离直至骨下关节外缘，接着使用克氏针钉入外踝上、舟状骨、距骨头，将皮瓣、腓骨长短肌腱向上牵开，充分暴露距下关节间隙外、后侧，利用骨膜剥离器撬起翻转、塌陷的关节面，必要时用一枚粗斯氏针自跟骨结节顶点打入距下关节面下方进行固定，通过撬拨、足跖屈，显露距下关节面，根据跟骨解剖形态使内骨块进行复位，同时恢复跟骨前中后三个关节面的解剖位置。植骨组：在行未植骨组相同治疗基础上，将备好的体积为2 cm × 2 cm × 2 cm以上髂骨修剪成火柴大小髂骨方条填入撬拔复位后距下关节下方出现的空腔，进行植骨，复位外侧壁并压平，C形臂机透视跟骨侧轴位及Broden位，跟骨外形及关节面平整度恢复满意后进行相应的钢板固定，放置引流管与术区内，间断缝合皮下后，用3-0可吸收线皮内进行皮肤缝合。术中采用跟骨可塑形异形钢板(北京理贝尔生物工程研究所)、植骨采用异体骨(北京鑫康辰公司)或自体髂骨。, 百拇医药(李延炜)