经跗骨窦切口与经外侧“L”型切口治疗SandersⅢ型骨折的疗效比较  

Comparison of sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type Ⅲ calcaneal fractures

作　　者：伍凯[1] 林健[1] 黄建华[1] 王秋根[1] 

机构地区：[1]上海交通大学附属第一人民医院创伤急救中心,201620

出　　处：《中华骨科杂志》2015年第8期825-832,共8页Chinese Journal of Orthopaedics

摘　　要：目的比较经跗骨窦切口有限切开复位内固定与经外侧“L”型切口内固定治疗SandersⅢ型跟骨骨折的疗效。方法2011年8月至2014年2月收治35例（36侧）SandersⅢ型跟骨骨折患者，男27例，女8例。18例（19侧）采用经跗骨窦切口有限切开复位内固定治疗（微创组），17例（17侧）采用经外侧“L”型切口切开复位内固定（传统组）。影像学评价包括Bshler角及Gissane角，临床疗效评价包括美国足踝外科协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝-后足评分、疼痛视觉模拟评分（visual analogue scale，VAS）和健康调查简表（the MOS item short from healthsurvey，SF-36）。结果微创组术后随访平均（14．6±2．36）个月，传统组（18．3±2．34）个月，所有骨折均获得骨性愈合。微创组和传统组B6hler角及Gissane角的术后值及末次随访值，均较术前显著增加，差异有统计学意义。微创组AOFAS评分、VAS评分和SF-36评分为（84．74±8．14）分，（1．68±0．95）分和（89．36±4．69）分；传统组AOFAS评分、VAS评分和SF-36评分为（82．06±10．95）分，（1．94±1．43）分和（86．71±5．39）分，差异无统计学意义。微创组无血肿形成、皮缘坏死、伤15裂开及骨髓炎等切口问题发生，距下关节僵硬3侧，距下关节创伤性关节炎1侧。传统组发生切口并发症2侧（1侧血肿形成，1侧伤口裂开），距下关节僵硬8侧，距下关节创伤性关节炎2侧。结论经跗骨窦切口有限切开复位内固定治疗SandersⅢ骨折可以取得与经外侧“L”型切口相似的疗效，但前者切口并发症发生率和距下关节僵硬发生率更低。Objective This study is aimed to compare sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type Ⅲ ealeaneal fractures. Methods A total of 36 cases of Sanders type Ⅲ ealcaneal fractures treated in our hospital between August 2011 to February 2014（35 patients, 27males, 8 females. Nineteen of them were performed a limited open reduction and internal fixation（ORIF） via the sinus tarsi approach（as minimal invasive group）, while the other 17 cases were performed ORIF via conventional lateral extensile L shape approach（as conventional group）. X-ray films were taken postoperatively to record the changes of Bohler angle and Gissane angle. The AOFAS ankle hind-foot scale, visual analogue scale and the MOS item short from health survey（SF-36） were adopted to assess the therapeutic effect. Results The average follow-up period of minimal invasive group was 14.6 months. And conventional group were followed up for average period of 18.3 months. All the fractures in the series had a boney union at or before the final follow-up. The immediate correction and final correction of Bohler angle and Gissane angle were significantly increased in both minimal invasive group and conventional group, while there was significant difference between the two groups. The median AOFAS score ,VAS score and SF-36 score of the minimal invasive group were 84.74±8.14, 1.68±0.95 and 89.36±4.69, while those in the conventional group were 82.06±10.95, 1.94±1.43and 86.71±5.39. There was no significant statistically difference between the two groups. No wound problem happened in the minimal invasive group, 3 cases of subtalar joint stiffness were found, and 1 developed traumatic arthritis. Respectively, 2 cases in conventional group got hematoma and dehiscence for each, 8 cases of subtalar joint stiffness were found, and 2 cases developed traumatic arthritis finally. Conclusion Limited ORIF via a sinus tarsi incision have the familiar therapeutic effects to ORIF via a conventional exte

关 键 词：跟骨 骨折固定术 内 术后相关并发症 

分 类 号：R687.3[医药卫生—骨科学]