Objective By analyzing the clinical and radiologic results after operation ,the clinical differences between locking plate fixation and minimally invasive poking reduction and hollow nail fixation in the treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures were compared.Methods A total of 48 patients with unilateral calcaneal fracture admitted from Apr.2011 to May 2015 in Shanghai Changhai Hospital were selected.The ratio of male and fe-male was 40∶8.At the same time, the age range was 20 to 46 years,with an average age of 37.5 years, and the time from injury to surgery ranged from 3 to 7 days,with an average of 5.0 days.According to random number table meth-od,24 cases were treated with locking plate internal fixation (locking group,17 cases of typeⅡ,7 cases of typeⅢ) and 24 were treated with minimally invasive poking reduction and internal fixation with hollow nail (minimally invasive group, n＝24,typeⅡn＝18,typeⅢn＝6).They were followed up for 9-12 months to observe the treatment effect. Results The operation time of the patients in the minimally invasive group was longer than that in the locking group , the amount of bleeding during the operation ,the time of hospitalization was less/shorter than the locking group ,and the difference was statistically significant (P＜0.05).The recovery of calcaneal width ,length of B?lher angle were Gissane angle were significantly better in the minimally invasive group than in the locking group ,and the difference was statisti-cally significant(P＜0.05), but did not have statistical difference in the B?lher angle(P＞0.05).There was no com-plication in the minimally invasive group ,the incidence of complications in the locking group was 12.5%,and the difference was significant (P＜0.05).The pain score in minimally invasive group was (4.30 ±0.98)points on the first day,(2.84 ±0.73)points on the seventh day,and (1.03 ±0.11)points before discharge,which were all better than those in the locking group (((5.72 ±1.42)points,(4.05 ±0.82)points,(2.76 ±0.73)points),respectively),and the difference was statistically significant(P＜0.05).Conclusion In the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures,minimally invasive poking reduction with hollow nail fixation and locking plate fixation can obviously improve the Bolher angle of the patients,but the minimally invasive operation is safe with rapid recovery,and is worth popularizing.%目的 通过对术后临床结果和放射学结果进行分析,对比锁定钢板内固定和微创撬拨复位空心钉内固定在治疗SandersⅡ和Ⅲ型跟骨骨折上的临床差异.方法 选取上海市长海医院2011年4月—2015年5月收治的单侧跟骨骨折患者48例,男性40例,女性8例;年龄20～46岁,平均37.5岁;受伤至手术时间3～7d,平均5.0d.按随机数字表法分成锁定钢板内固定(锁定组,24例,其中Ⅱ型17例,Ⅲ型7例),微创撬拨复位空心钉内固定(微创组,24例,其中Ⅱ型18例,Ⅲ型6例).随访9～12个月观察两组患者的治疗效果.结果 微创组患者的手术时间长于锁定组,术中出血量、住院时间少(短)于锁定组,差异有统计学意义(P＜0.05);跟骨宽度、长度B?lher角及Gissane角恢复情况,两组均较术前有明显改善(P＜0.05),术后两组间B?lher角差异无统计学意义(P＞0.05).微创组无并发症发生,锁定组并发症发生率为12.5%,前者明显低于后者(P＜0.05).微创组治疗后疼痛评分值分别为第1天(4.30 ±0.98)、第7天(2.84 ±0.73)、出院前(1.03 ±0.11),均优于锁定组第1天(5.72 ±1.42)、第7天(4.05 ±0.82)、出院前(2.76 ±0.73),差异有统计学意义(P＜0.05).结论 在SandersⅡ和Ⅲ型跟骨骨折的治疗中采用微创撬拨复位空心钉内固定和锁定钢板内固定手术均可改明显改善患者的B?lher角,但微创手术的安全性较高,恢复速度快,值得推广.
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