| Objective: To investigate the clinical efficacy of titanium alloy special-shaped plate fixation in the treatment of intra-articular calcaneal fracture, summarize the treatment experiences and draw lessons from complications, thereby providing data supports for clinical application effect and superiority of titanium alloy special-shaped plate in intra-articular calcaneal fracture.Methods: From June2012to June2013,48patients of calcaneal fracture according to the diagnostic standard were chosen from the department of orthopedics of Xinxiang Second People’s Hospital, included28males and20females, involved a total of50feet,2patients injured both feet,48patients were no fractures in other parts. All patients were given CT scan on the fracture calcaneum lateral, axial and coronal image before surgery, then were classified according to the calcaneal fractures Sanders CT classification criteria after three-dimensional reconstruction, including18cases of Sanders type Ⅱ,20cases of Sanders type Ⅲ, and12cases of Sanders type Ⅳ. In38cases accepted operation within2days after injured, and12cases were operated after injured5～12days. All cases were treated by expand open reduction through lateral approach, and internal fixation by titanium bone shaped titanium plate with bone grafting in8cases used iliac crest autograft or allograft bone to support the down articular surface, all patients were guided to have rehabilitative exercise from the third postoperative days.Patients were followed up for6-9months, average8.2months, the image and data of pre-and postoperative were compared, and the follow-up data were scored according to the Maryland foot score system to analysis of the efficacy and complications. Results: The group included48patients, involved a total of50feet. Scored feet function according to Maryland rating criteria at the end of follow-up, the postoperative Bohler angle of type Ⅱ, typeⅢ, type Ⅳ were29.35°±3.36°,27.61°±3.23°,25.12°±3.45°respectively, compared with preoperative18.53°±2.58°,16.69°±3.28°,16.03°±4.20°had improved significantly, p values were less than0.05; The postoperative Gissane angle of type Ⅱ was136.56°±4.28°, and Gissane angle of type Ⅲ wasl38.38°±5.56°,there was no significant statistical difference between them, p=0.2685>0.05. But the postoperative Gissane angle of type Ⅱ and type Ⅲ were significantly lower than type IV which was142.15°±3.43°, p values were less than0.05.During the follow-up period,2feet (4.0%of the total cases) occurred local skin erosion necrosis on the cut edge,1foot (2%of the total cases) occurred traumatic arthritis,1foot (2%of the total cases) occurred sural nerve injury, no peroneal tendonitis and deep infection.Conclusion: The clinical curative effect of titanium plates fixation in the treatment of Sanders Ⅱ-Ⅳ type calcaneal fractures is exact and reliable, especially for Sanders Ⅱ-Ⅲ type calcaneal fractures has a higher good rate and fewer complications than Sanders Ⅳ type, and be worthy of clinical application. |
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