锁定钢板联合同种异体骨/自体骨移植治疗Sanders Ⅲ、Ⅳ型跟骨骨折
|
摘要
目的比较锁定钢板内固定联合同种异体骨或自体骨移植治疗Sanders Ⅲ、Ⅳ型跟骨骨折的临床疗效。方法回顾性分析我院2013年4月至2016年4月采用锁定钢板内固定联合骨移植材料填充治疗的88例单侧Sanders Ⅲ、Ⅳ型跟骨骨折病人的临床资料。43例采用同种异体骨填充(同种异体骨组),45例采用自体骨填充治疗(自体骨组)。比较两组术前、术后12个月跟骨B?hler角、Gissane角,术后完全负重时间,跟骨高度丢失情况以及术后并发症,采用美国足踝外科医师协会(American Orthopedic Foot and Ankle Society, AOFAS)踝与后足功能评分系统评价患足功能。结果所有病人平均随访12个月,术后12个月两组跟骨Gissane角、B?hler角均较术前恢复,差异有统计学意义(P均<0.05),但两组间的差异无统计学意义(P>0.05);同种异体骨组和自体骨组术后完全负重时间[(6.23±0.83)个月vs.(5.92±0.83个月)]、患足AOFAS评分[(79.64±14.54)分vs.(82.21±11.74)分]、跟骨高度丢失量[(2.16±0.39)mm vs.(2.33±0.38)mm]、并发症发生率(23.26%vs. 24.44%)之间的差异均无统计学意义(P均>0.05)。结论锁定钢板联合同种异体骨或自体骨移植治疗SandersⅢ、Ⅳ型跟骨骨折均能减轻疼痛,纠正跟骨畸形,恢复足功能,疗效无明显差异。
Objective To analyze the clinical effects of locking plates fixation combined with allograft or autologous iliac bone graft in the treatment of Sanders Ⅲ, Ⅳ calcaneal fractures. Methods From April 2013 to April 2016, 88 patients with unilateral Sanders Ⅲ, Ⅳ calcaneal fractures were treated by locking plates fixation combined with allograft or autologous iliac bone graft. The patients were divided into allograft group(43 cases) with allograft and autograft group(45 cases) with autologous iliac bone graft. The clinical efficacy was assessed through analyzing the B?hler and Gissane angle restoration before and 12 months post-surgery. The weight bearing time, American Orthopedic Foot and Ankle Society(AOFAS) score and heel height loss of calcaneus at 12 th month after operation, and postoperative complications were compared between the two groups. Results All cases were followed up for 12 months. At 12 th month after surgery, the Gissane and B?hler angles were significantly improved as compared with those before surgery(both P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in weight bearing time[(6.23±0.83) vs.(5.92±0.83) months]between the two groups(P>0.05). At 12 th month postsurgery, there was no significant difference in AOFAS score(79.64±14.54 vs. 82.21±11.74) and calcaneal height loss[(2.16±0.39) vs.(2.33±0.38) mm]and postoperative complication rate(23.26% vs. 24.44%) between the two groups(all P>0.05). Conclusion The locking plates fixation combined with allograft or autologous iliac bone graft achieved similar clinical effects in the treatment of Sanders Ⅲ and Ⅳ calcaneal fractures with satisfactory effects in relieving the heel pain, correcting heel bone deformity and restoring foot function.
Objective To analyze the clinical effects of locking plates fixation combined with allograft or autologous iliac bone graft in the treatment of Sanders Ⅲ, Ⅳ calcaneal fractures. Methods From April 2013 to April 2016, 88 patients with unilateral Sanders Ⅲ, Ⅳ calcaneal fractures were treated by locking plates fixation combined with allograft or autologous iliac bone graft. The patients were divided into allograft group(43 cases) with allograft and autograft group(45 cases) with autologous iliac bone graft. The clinical efficacy was assessed through analyzing the B?hler and Gissane angle restoration before and 12 months post-surgery. The weight bearing time, American Orthopedic Foot and Ankle Society(AOFAS) score and heel height loss of calcaneus at 12 th month after operation, and postoperative complications were compared between the two groups. Results All cases were followed up for 12 months. At 12 th month after surgery, the Gissane and B?hler angles were significantly improved as compared with those before surgery(both P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in weight bearing time[(6.23±0.83) vs.(5.92±0.83) months]between the two groups(P>0.05). At 12 th month postsurgery, there was no significant difference in AOFAS score(79.64±14.54 vs. 82.21±11.74) and calcaneal height loss[(2.16±0.39) vs.(2.33±0.38) mm]and postoperative complication rate(23.26% vs. 24.44%) between the two groups(all P>0.05). Conclusion The locking plates fixation combined with allograft or autologous iliac bone graft achieved similar clinical effects in the treatment of Sanders Ⅲ and Ⅳ calcaneal fractures with satisfactory effects in relieving the heel pain, correcting heel bone deformity and restoring foot function.
引文
[1]俞光荣,燕晓宇.跟骨骨折治疗方法的选择[J].中华骨科杂志,2006,26(2):134-141.
[2]邱皓,栾富钧,曹春风,等.手术与非手术治疗移位型跟骨关节内骨折的Meta分析[J].中国矫形外科杂志,2016,24(2):133-140.
[3]曹立海,彭义,闫荣亮,等.累及跟距关节及跟骰关节损伤的跟骨骨折手术治疗[J].中国修复重建外科杂志,2013,27(2):169-172.
[4]晏波,厉泽众,代立武.小切口微创内固定治疗SandersⅡ、Ⅲ型跟骨骨折49例[J].骨科,2018,9(4):327-329.
[5]魏利成,余世明,刘丹平.解剖钢板内固定并植骨治疗跟骨骨折骨缺损的临床研究[J].中国骨与关节损伤杂志,2010,25(10):897-899.
[6]Singh AK,Vinay K.Surgical treatment of displaced intra-articular calcaneal fractures:is bone grafting necessary?[J].J Orthop Traumatol,2013,14(4):299-305.
[7]朱康,马明,鲍启忠.解剖锁定钢板内固定结合植骨与不植骨治疗SandersⅢ、Ⅳ型跟骨骨折的效果比较[J].中国医学创新,2018,15(14):24-28.
[8]Westphal T,Piatek S,Halm JP,et al.Outcome of surgically treated intraarticular calcaneus fractures SF-36 compared with AOFASand MFS[J].Acta Orthop Scand,2004,75(6):750-755.
[9]Blake MH,Owen JR,Sanford TS,et al.Biomechanical evaluation of a locking and nonlocking reconstruction plate in an osteoporotic calcaneal fracture model[J].Foot Ankle Int,2011,32(4):432-436.
[10]Gavlik JM,Rammelt S,Zwipp H.Percutaneous,arthroscopicallyassisted osteosynthesis of calcaneus fractures[J].Arch Orthop Trauma Surg,2002,122(8):424-428.
[11]Wei N,Yuwen P,Liu W,et al.Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures:a meta-analysis of current evidence base[J].Medicine(Baltimore),2017,96(49):e9027.
[12]Su J,Cao X.Can operations achieve good outcomes in elderly patients with SandersⅡ-Ⅲcalcaneal fractures?[J].Medicine(Baltimore),2017,96(29):e7553.
[13]Thornes BS,Collins AL,Timlin M,et al.Outcome of calcaneal fractures treated operatively and non-operatively.The effect of litigation on outcomes[J].Ir J Med Sci,2002,171(3):155-157.
[14]许文斌,徐义春,姚辉,等.自固化磷酸钙人工骨与异体骨治疗SandersⅡ-Ⅳ型跟骨骨折的病例对照研究[J].中国骨伤,2018,31(7):594-598.
[15]张坚若,沈是铭,陈永坚,等.植骨与非植骨治疗跟骨骨折的疗效比较[J].临床骨科杂志,2013,16(1):73-75.
[16]Chun HJ,Oh SH,YI HJ,et al.Efficacy and durability of the titanium mesh cage spacer combined with transarticular screw fixation for atlantoaxial instability in rheumatoid arthritis patients[J].Spine(Phila Pa 1976),2009,34(22):2384-2388.
[2]邱皓,栾富钧,曹春风,等.手术与非手术治疗移位型跟骨关节内骨折的Meta分析[J].中国矫形外科杂志,2016,24(2):133-140.
[3]曹立海,彭义,闫荣亮,等.累及跟距关节及跟骰关节损伤的跟骨骨折手术治疗[J].中国修复重建外科杂志,2013,27(2):169-172.
[4]晏波,厉泽众,代立武.小切口微创内固定治疗SandersⅡ、Ⅲ型跟骨骨折49例[J].骨科,2018,9(4):327-329.
[5]魏利成,余世明,刘丹平.解剖钢板内固定并植骨治疗跟骨骨折骨缺损的临床研究[J].中国骨与关节损伤杂志,2010,25(10):897-899.
[6]Singh AK,Vinay K.Surgical treatment of displaced intra-articular calcaneal fractures:is bone grafting necessary?[J].J Orthop Traumatol,2013,14(4):299-305.
[7]朱康,马明,鲍启忠.解剖锁定钢板内固定结合植骨与不植骨治疗SandersⅢ、Ⅳ型跟骨骨折的效果比较[J].中国医学创新,2018,15(14):24-28.
[8]Westphal T,Piatek S,Halm JP,et al.Outcome of surgically treated intraarticular calcaneus fractures SF-36 compared with AOFASand MFS[J].Acta Orthop Scand,2004,75(6):750-755.
[9]Blake MH,Owen JR,Sanford TS,et al.Biomechanical evaluation of a locking and nonlocking reconstruction plate in an osteoporotic calcaneal fracture model[J].Foot Ankle Int,2011,32(4):432-436.
[10]Gavlik JM,Rammelt S,Zwipp H.Percutaneous,arthroscopicallyassisted osteosynthesis of calcaneus fractures[J].Arch Orthop Trauma Surg,2002,122(8):424-428.
[11]Wei N,Yuwen P,Liu W,et al.Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures:a meta-analysis of current evidence base[J].Medicine(Baltimore),2017,96(49):e9027.
[12]Su J,Cao X.Can operations achieve good outcomes in elderly patients with SandersⅡ-Ⅲcalcaneal fractures?[J].Medicine(Baltimore),2017,96(29):e7553.
[13]Thornes BS,Collins AL,Timlin M,et al.Outcome of calcaneal fractures treated operatively and non-operatively.The effect of litigation on outcomes[J].Ir J Med Sci,2002,171(3):155-157.
[14]许文斌,徐义春,姚辉,等.自固化磷酸钙人工骨与异体骨治疗SandersⅡ-Ⅳ型跟骨骨折的病例对照研究[J].中国骨伤,2018,31(7):594-598.
[15]张坚若,沈是铭,陈永坚,等.植骨与非植骨治疗跟骨骨折的疗效比较[J].临床骨科杂志,2013,16(1):73-75.
[16]Chun HJ,Oh SH,YI HJ,et al.Efficacy and durability of the titanium mesh cage spacer combined with transarticular screw fixation for atlantoaxial instability in rheumatoid arthritis patients[J].Spine(Phila Pa 1976),2009,34(22):2384-2388.