SandersⅡ型跟骨骨折不同入路切开复位内固定疗效及对距下关节活动度的影响  

Clinical outcome of open reduction and internal fixation through different approachesClinical approachesfor Sandersfor Sanders Ⅱ of calcaneus fractures and its influence on subtalar joint activityof activity

作　　者：戴鹏[1] 孙劲[1] 黄晖[1] 付纳新[1] 刘鹏宇[1] 叶俊刚 

机构地区：[1]三峡大学第三临床医学院葛洲坝中心医院骨科,宜昌443002

出　　处：《中国骨与关节外科》2014年第4期285-288,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:跟骨是骨折常见部位,解剖学结构复杂,复位难度较大。手术是关节内骨折治疗的主要策略,既可恢复骨折部位形态,又可达到关节面重建的效果。目前选择何种入路治疗SandersⅡ型跟骨骨折尚存在争议。目的:探讨不同入路切开复位内固定在SandersⅡ型跟骨骨折治疗中的效果及其对距下关节活动度的影响。方法:回顾分析本院2011年2月至2013年9月接受跗骨窦间隙入路切开复位内固定治疗的26例SandersⅡ型跟骨骨折患者治疗情况(观察组),收集手术相关指标(手术时间、术中失血量、切口长度、术后引流量及VAS评分),测量术前、术后3个月的跟骨长、宽、高度及B?hler和Gissane角,采用Maryland评分及AOFAS评分评价术后6个月的恢复情况,Morrey法评价术后6个月的距下关节活动度并记录末次随访的并发症情况。选取同期的28例接受"L"形外侧扩大入路切开复位内固定的SandersⅡ型跟骨骨折患者作为对照(对照组)。结果:两组的手术时间、术中失血量的差异无统计学意义(P>0.05)。观察组的切口长度小于对照组,术后引流量及术后VAS评分均低于对照组,差异均有统计学意义(P<0.05)。两组术后跟骨长、宽、高度及B?hler和Gissane角均优于术前,但两组的差异无统计学意义(P>0.05)。观察组术后6个月的Maryland评分和AOFAS评分均高于对照组,且距下关节的重度受限率及评分均较低,而轻度受限率较高,以上差异均有统计学意义(P<0.05)。而两组并发症发生率的差异无统计学意义(P>0.05)。结论:经跗骨窦间隙入路切开复位内固定治疗SandersⅡ型跟骨骨折患者的效果较好,促进术后恢复并减少对距下关节功能的影响。Background：Calcaneus is a common position of fracture. It is difficult to reset due to its complicated anatomic structure. As a popular strategy for intra-articular fracture, surgical treatment can not only recover appearance of injured calcaneus, but al-so reconstruct articular surface. However, it is still a controversy to choose approaches for SandersⅡof calcaneus fractures. Objective：To explore clinical outcomes of open reduction and internal fixation for SandersⅡof calcaneus fractures though different approaches and its influences on subtalar joint activity. Methods：In this retrospective study, 26 patients with SandersⅡof calcaneus fractures who underwent open reduction and internal fixation through the sinus tarsi approach between February 2011 and September 2013 were enrolled in observed group. Operative parameters, such as operation time, intraoperative blood loss, incision length, postoperative drainage vol-ume and VAS score were collected. The calcaneal length, width and height were measured before surgery and 3 months af-ter surgery as well as B？hler and Gissane angles. The Maryland score and AOFAS score were employed to evaluate the re-covery at 6th months after surgery. Subtalar joint activity was assessed by the Morrey method. The complications were re-corded at the the last follow-up. Meanwhile, 28 patients with SandersⅡof calcaneal fractures who received open reduction and internal fixation through L-shaped lateral expansion approach were chosen as controls. Results： No significant difference was observed on operation duration and intraoperative blood loss between both groups （P〉0.05）. There were shorter incision length and lower postoperative drainage and postoperative VAS scores in observed group versus control group （P〈0.05）. The postoperative parameters of calcaneus were superior to preoperative ones in both groups （P〈0.05）, while no significant differences were observed between groups （P〉0.05）. The Maryland score and AO-FAS score of observed group wer

关 键 词：跗骨窦间隙入路 “L”形外侧扩大入路 内固定 跟骨关节内骨折 距下关节 

分 类 号：R687.3[医药卫生—骨科学]