贵州医科大学学报

2019, v.44;No.229(10) 1205-1209+1214

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微型锁定接骨板组合经皮螺钉内固定对跟骨SandersⅡ~Ⅲ型闭合骨折的疗效及机制
Curative Effects and Mechanism of Mini-Locking Plate Combined with Percutaneous Screw Internal Fixation in the Treatment of Patients with Sanders Type Ⅱ~Ⅲ Calcaneus Closed Fracture

孙勃;刘士波;王培;薛鑫鑫;高云峰;付世杰;
SUN Bo;LIU Shibo;WANG Pei;XUE Xinxin;GAO Yunfeng;FU Shijie;Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University;

摘要(Abstract):

目的:探讨微型锁定接骨板组合经皮螺钉内固定对跟骨SandersⅡ~Ⅲ型闭合骨折的疗效及患者血清氧诱导因子1α(HIF-1α)、血管内皮生长因子(VEGF)表达的影响。方法:56例行微型锁定接骨板组合经皮螺钉内固定治疗的跟骨SandersⅡ~Ⅲ型闭合骨折患者作为实验组,54例行切开复位钢板内固定治疗跟骨SandersⅡ~Ⅲ型闭合骨折患者作为对照组;比较2组患者手术时间、切口愈合时间、住院总时间、术中出血量及术后并发症,观察2组患者术后6个月时的足功能恢复优良率;于治疗前及术后3个月时测量2组患者的跟骨长度、高度、宽度、Bhler角及Gissane角;于治疗前及术后3 d时,采用酶联免疫吸附法检测2组患者血清HIF-1α及VEGF水平。结果:实验组患者手术时间长于对照组,切口愈合时间、住院总时间短于对照组,术中出血量少于对照组,术后并发症发生率(3.58%)低于对照组(14.81%),差异有统计学意义(P<0.01或P<0.05);术后6个月时,2组患者足功能恢复优良率比较,差异无统计学意义(P>0.05);实验组患者跟骨长度与高度大于对照组、跟骨宽度小于对照组,Bhler角、Gissane角大于对照组,差异有统计学意义(P<0.01);术后3 d时,实验组患者血清HIF-1α、VEGF水平高于对照组,差异有统计学意义(P<0.01)。结论:微型锁定接骨板组合经皮螺钉内固定对跟骨SandersⅡ~Ⅲ型闭合骨折疗效优于常规手术治疗,其机制可能与HIF-1α、VEGF水平增高、术后骨折端血管新生有关。
Objective: To explore effect of mini-locking plate combined with percutaneous screw internal fixation on expression of serum hypoxia inducible factor-1α(HIF-1α) and vascular endothelial growth factor(VEGF) of patients with Sanders type Ⅱ~Ⅲ calcaneus closed fracture of and influences. Methods: Micro-locking plate combined with percutaneous screw internal fixation were performed on patients with Sanders type Ⅱ~Ⅲ calcaneus closed fracture were included into group experiment, while 54 Sanders type Ⅱ~Ⅲ calcaneus closed fracture patients received open reduction and plate internal fixation were included into control group. Comparing operation time, joint recovery time, total hospital stay time, blood loss amount during operation, post-operation complication; observing function recovery rate of both groups six month after surgery. Measuring length of calcaneus, height, width, Bhler angle and Gissane angle; before and three days after surgery, adopting ELISA assay to test serum HIF-1αand VEGF level. Results: The operation time of experiment group was longer than that of control group, while incision healing time and total hospitalization time were shorter than those of control group, the complication occurrence rate(3.58%) was lower than control group(14.81%), difference was statistically significant(P<0.01 or P<0.05). six months after treatment, foot function of both groups showed no statistical difference(P>0.05); the length of calcaneus and height of experiment group was bigger than that of control group, the width was smllar than control group; Bhler angle and Gissane angle in experiment group were larger than those in control group, differences were statistically significant(P<0.01); three days after treatment, levels of serum HIF-1α and VEGF in experiment group were higher than those in control group(P<0.01). Conclusion: The effect of mini-locking plate combined with percutaneous screw internal fixation on patients with Sanders type Ⅱ~Ⅲ calcaneus closed fracture was better than conventional treatment. The mechanism might be related to the increase HIF-1αand VEGF level, and post-operation vasculogenesis of fracture.

关键词(KeyWords): 跟骨;闭合骨折;微型锁定接骨板;经皮螺钉内固定;血清氧诱导因子1α;血管内皮生长因子
calcaneus;closed fracture;mini-locking plate;percutaneous screw internal fixation;serum hypoxia inducible factor-1α;vascular endothelial growth factor

Abstract:

Keywords:

基金项目(Foundation): 河北省医学科学研究重点课题(20150017)

作者(Authors): 孙勃;刘士波;王培;薛鑫鑫;高云峰;付世杰;
SUN Bo;LIU Shibo;WANG Pei;XUE Xinxin;GAO Yunfeng;FU Shijie;Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University;

DOI: 10.19367/j.cnki.1000-2707.2019.10.018

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