| Objective To compare and analyze the curative effects of bone grafting and non-grafting in the treatment of Sanders type Ⅱ calcaneal fractures during open reduction and internal fixation with calcaneal anatomical locking plate,in order to provide reference for the clinical treatment of calcaneal fractures.Methods A total of 65 patients with Sanders type II calcaneal fractures who were admitted to the Third Affiliated Hospital of Anhui Medical University（Hefei First People’s Hospital and Binhu Hospital）from December 2016 to August 2019 were retrospectively analyzed,including 46 males.,19 females,aged 24 to 60 years old;55cases were injured by falling from heights,7 cases were injured by traffic accidents,and 3 cases were injured by heavy objects.The patients with calcaneal fractures who underwent open reduction and internal fixation with Anatomical Locking Plate were divided into two groups according to whether artificial bone was implanted into the cavity left after reduction and fracture,respectively,the bone graft group and the non-bone graft group.Among them,there were 34 cases in the bone graft group,including 24 males and 10 females,aged 24 to 60 years old,with an average age of（44.65±8.91）years old.There were 28 cases of falling from heights,4 cases of traffic accident injuries,and 4 cases of heavy object injury.2 cases;31 cases in the non-bone graft group,including 22 males and 9 females,aged 27 to 57 years old,with an average age of（43.23±7.12）years old,27 cases of falling from heights,3 cases of traffic accident injuries,serious injuries.1 case was injured by objects.By comparing the operation time,intraoperative blood loss,length of hospital stay,postoperative weight-bearing time,postoperative complications,calcaneal height at 1 year after operation,Bohler angle size and Maryland foot function score between the two groups to understand whether the operation was The effect of implantation of artificial bone on surgical outcomes.Results All study subjects obtained complete follow-up data and obtained corresponding data,imaging data and Maryland foot function score.All patients were followed up for more than 12 months.No internal fixation fracture,loosening or failure occurred in all patients during the follow-up period.The operation time of the patients in the bone graft group and the non-bone graft group were（68.8±8.7）min and（66.0±8.5）min,respectively,the intraoperative blood loss was（54.1±8.9）ml and（50.6±10.9）ml,and the length of hospital stay were（23.3±2.2）d and（22.6±1.8）d,respectively,and the postoperative weight-bearing time was（3.1±0.3）months and（3.3±0.5）months,respectively.Compared with the above data,the difference was not statistically significant（P >0.05）;calcaneal heights were（42.2±1.8）mm and（41.9±1.6）mm,and Bohler angles were（27.7±2.7）° and（26.5±3.4）° at 1 year after operation.There was no significant difference between the two groups（P>0.05）,and the corresponding indexes in each group were compared with those before operation,and the difference was statistically significant（P<0.05）.The foot function scores were（90.4±4.7）and（89.4±6.9）respectively,and there was no significant difference between the two（P>0.05）.In terms of postoperative complications,there were 7 cases in the bone graft group and 3 cases in the non-bone graft group with delayed healing of the incision.After regular dressing changes and appropriate application of antibiotics,the incisions were healed;in the bone graft group,1 case occurred in the non-bone graft group.There was 1 case of postoperative incision infection in the group,which healed after long-term dressing change and treatment with sensitive antibiotics according to the results of exudate culture;2 cases in the bone graft group and 1 case in the non-bone graft group had skin necrosis around the incision.In the bone graft group,3 cases of postoperative rejection occurred,and they were cured after regular dressing changes and rational use of antibiotics.The postoperative complication rates of the bone graft group and the non-bone graft group were 38.23%and 16.13%,respectively.The postoperative complication rate of the non-bone graft group was lower than that of the bone graft group,and the difference was statistically significant（P<0.05）.Conclusion According to the results of this study,for patients with Sanders type Ⅱcalcaneal fracture,compared with implantation of artificial bone,no bone grafting combined with open reduction and internal fixation with anatomical locking plate can reduce incision infection on the premise of obtaining the same or similar efficacy as the former.It is worthy of clinical application and promotion. |
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