Liang Jun, Cao Hong-bin, Xin Jing-yi
Department of Orthopedics, Tianjin Hospital, China.
Zhonghua Yi Xue Za Zhi. 2012 Jan 17;92(3):197-9.
To evaluate the efficacies of treating intra-calcaneal fractures with bone grafting.
From January 2005 to October 2011, a total of 182 calcaneal patients underwent operations for closed fractures. There were 159 males and 23 females with an average age of 41.2 years old. The fractures were of the following types: left calcaneal (n = 68), right calcaneal (n = 86) and bilateral (n = 28). According to the Sander's classification, there were type II (n = 27), type III (n = 109) and type IV (n = 46). And they were divided into bone graft (n = 94) and non-bone graft (n = 88) groups. All of them underwent a profiled plate fixation via a lateral approach. No external fixation was necessary and early ankle functional exercises started postoperatively. They handled partial weight-bearing at Week 6 and full weight-bearing at Week 12. Their outcomes were assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) while classification comparison affected the prognosis (P < 0.05).
The follow-ups of 10 patients were lost at Month 3. And 172 cases were followed up for an average period of 14.2 months (range: 9 - 16). The average healing duration was 12 weeks (range: 6 - 15). None of follow-up cases had any complication, such as vascular and nerve injury and osteomyelitis. Twenty-nine cases in the non-bone graft group had articular cave-in after weight bearing. And 21 cases were associated with subtalar arthritis. And in the bone graft group, there was no articular cave-in and only 1 case was associated with subtalar arthritis. The outcomes of bone graft and non-graft groups were as follows: excellent (n = 68), good (n = 20), fair (n = 5) and poor (n = 1) vs. excellent (n = 44), good (n = 26), fair (n = 7) and poor (n = 9). The rate of excellent and good was 87.9%. And the post-operative AOFAS scores had statistical differences between 2 groups (P < 0.05).
Bone grafting is important for improving the therapeutic efficacies for intra-calcaneal fractures.
评估植骨治疗跟骨骨折的疗效。
2005年1月至2011年10月，共有182例跟骨闭合性骨折患者接受手术治疗。其中男性159例，女性23例，平均年龄41.2岁。骨折类型如下：左侧跟骨骨折（n = 68），右侧跟骨骨折（n = 86），双侧跟骨骨折（n = 28）。根据Sanders分型，Ⅱ型27例，Ⅲ型109例，Ⅳ型46例。将患者分为植骨组（n = 94）和非植骨组（n = 88）。所有患者均采用外侧入路解剖钢板固定。无需外固定，术后早期开始踝关节功能锻炼。术后6周部分负重，12周完全负重。采用美国矫形足踝协会踝-后足评分（AOFAS）评估疗效，而分型比较对预后有影响（P < 0.05）。
3个月时10例患者失访。172例患者获得随访，平均随访时间14.2个月（范围：9 - 16个月）。平均愈合时间12周（范围：6 - 15周）。所有随访病例均未出现血管神经损伤、骨髓炎等并发症。非植骨组29例患者负重后出现关节塌陷，21例并发距下关节炎。植骨组无关节塌陷，仅1例并发距下关节炎。植骨组与非植骨组疗效如下：优（n = 68）、良（n = 20）、可（n = 5）、差（n = 1）对比优（n = 44）、良（n = 26）、可（n = 7）、差（n = 9）。优良率为87.9%。两组术后AOFAS评分差异有统计学意义（P < 0.05）。
植骨对提高跟骨骨折的治疗效果具有重要意义。
