黄志锋+冼海庭+陈卫民

摘 要 目的：探讨自体骨移植联合钛板内固定术对跟骨压缩性骨折患者足功能的影响。方法：对2012年1月—2015年1月在我院采用自体骨移植联合钛板内固定术治疗跟骨压缩性骨折的35名患者进行1年随访研究，观察其手术前后跟骨B？hler角与Gissane角的变化情况以及术后愈合情况，并对其足功能进行评价。结果：与手术前比较，手术后的跟骨B？hler角明显增大，Gissane角则明显减小，差异有统计学意义（P<0.05）；35名患者中，术后X线片显示有25名已经达到解剖复位、10名接近解剖复位；按足功能评分系统，评为优的有22例、良10例、差3例，优良率达91.43%。结论：自体骨移植联合钛板内固定术对跟骨压缩性骨折患者的足功能恢复效果显著，值得临床进一步实践。

关键词 自体骨移植 钛板内固定术 跟骨压缩性骨折 B？hler角 Gissane角 足功能

中图分类号：R683.42； R687.3 文献标识码：B 文章编号：1006-1533（2016）05-0049-04

Effect of autogenous bone graft and titanium plate internal fixation on foot function in 35 cases of patients with calcaneal compression fractures*

HUAND Zhifeng**， XIAN Haiting， CHEN Weimin

（Gaobu Hospital of Dongguan City， Dongguan 523270， China）

ABSTRACT Objective： To evaluate the effect of autogenous bone graft and titanium plate internal fixation on foot function in patients with calcaneal compression fractures. Methods： Thirty-five patients with calcaneal compression fractures who received autogenous bone graft combined with titanium plate internal fixation from January， 2012 to January， 2015 in our hospital were selected and followed up for one year. The changes of both B？hler angle and Gissane angle of their bones before and after operation and the situation of postoperative healing were observed and moreover their foot function was also evaluated. Results： The B？hler angle was obviously increased and the Gissane angle was remarkably decreased after than before operation（P<0.05）. Postoperative X-ray showed that 25 patients reached to anatomical repositioning and 10 were close to anatomical repositioning. Twenty-two cases were assessed as excellent， 10 as good and 3 as bad with excellent and good rate 91.43% based on foot function score system. Conclusion： The efficacy of autogenous bone graft combined with titanium plate internal fixation for the treatment of patients with calcaneal compression fracture is remarkable and worthy of further clinical practice.

KEY WORDS autogenous bone graft； titanium plate internal fixation； calcaneal compression fracture； B？hler angle； Gissane angle； foot function

跟骨骨折在跗骨骨折中最常见，约占全部跗骨骨折的60%，多由高处跌下，足部着地，足跟遭受垂直撞击所引起，跌落的高度、地面性质及体重均为损伤的要素[1]。主要临床表现为足跟疼痛及压痛、足跟淤血、宽而扁的畸形以及跟骨向外倾斜呈外翻、外踝下方正常凹陷消失等[2]。跟骨压缩性骨折常可见距下关节面及体部有着明显的破坏、塌陷、下沉，如只采用非手术复位方法进行治疗，骨折复位后，常常发现跟骨体部尤其是距下后关节面下部有较大范围的骨质缺损，支撑不住已经复位的骨片，在应力作用下，骨折块倾向于骨质缺损处，若缺损部位得不到填充修复可能造成长时间渗血，致使伤口愈合延缓[3]。本研究采用自体骨移植联合钛板内固定术治疗跟骨压缩性骨折患者，取得了显著疗效，现将结果报道如下。

1 资料与方法

1.1 一般临床资料

选取2012年1月—2015年……