经跗骨窦入路与外侧扩大入路治疗Sanders Ⅱ型跟骨关节内骨折  

Sinus tarsi approach versus extensile lateral approach for the treatment of sanders type Ⅱ intra-articular calcaneal fractures

作　　者：孙晋客[1] 刘晓静[1] 王晨霖[1] 李嘉[1] 梁晓丽[1] 

机构地区：[1]山东省文登整骨医院足踝外科

出　　处：《足踝外科电子杂志》2015年第4期1-6,共6页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的 比较经跗骨窦入路与外侧扩大入路治疗跟骨SandersⅡ型关节内骨折的临床疗效及影像学资料,并比较并发症发生情况.方法 回顾性分析2012年1月至2014年12月山东省文登整骨医院采用经跗骨窦入路或外侧扩大入路治疗的87例（100足）SandersⅡ型跟骨关节内骨折患者的临床资料.根据治疗方式不同分为经跗骨窦入路组和外侧扩大入路组.经跗骨窦入路组共44例（48足）,按照Essex-lopresti分型,舌形骨折18例（19足）,关节面压缩骨折26例（29足）;外侧扩大入路组共43例（52足）,按照Essex-lopresti分型,舌形骨折15例（20足）,关节面压缩骨折28例（32足）.根据术后X线影像判断骨折愈合情况,测量Bohler角和Gissane角.采用美国足踝外科协会（AOFAS）踝与后足评分系统进行最终功能评定.记录并发症发生情况.结果 术后随访6-24个月,平均随访时间为14个月,骨折均于3个月内愈合.经跗骨窦入路组术后,Bohler角为10°-41°,平均23.5°;Gissane角为98°-141°,平均120.4°;AOFAS评分为76-100分,平均91.6分;其中优29足,良17足,可2足.外侧扩大入路组术后,Bohler角为8°-44°,平均24.6°;Gissane角为102°-136°,平均118.3°;AOFAS评分为72-100分,平均89.4分;其中优28足,良21足,可3足.两组影像学结果及临床资料比较差异无统计学意义（P〉0.05）,两组患者的软组织并发症发生率,差异有统计学意义（P〈0.05）;外侧扩大入路组2例患者伤口进行了清创手术.结论 经跗骨窦入路与外侧扩大入路均能有效治疗跟骨SandersⅡ型关节内骨折,影像学结果和临床疗效相当.经跗骨窦入路技术的并发症发生率更低,是跟骨关节内骨折治疗的一项微创、安全、有效的替代技术.Objective To compare the clinical and radiographic outcomes of Sanders type H intra-articular calcaneal fractures treated with open reduction and internal fixation via a sinus tarsi approach versus those with an extensile lateral approach, and observe their complications. Methods A retrospective review of Sanders type Ⅱ intra-articnlar calcaneal fractures treated with open reduction and internal fixation via a sinus tarsi approach or an extensile lateral approach between January 2012 and December 2014 were performed. 87 patients （100 feet） were enrolled into our study; 44（48 feet） were treated with a sinus tarsi approach and 43（52 feet） with an extensile lateral approach based on surgeon preference.Radiographs were obtained for all patients, including lateral and axial heel views, to assess fracture union and measure the angles of Bohler and Gissane. The final clinical outcomes was comprehensively assessed according to the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society （AOFAS）, and the complications were recorded. Results All the 87 cases were followed up for 6 to 24 months with an average of 14 months. X-ray demonstrated bone union in 3 months after the operation in both groups. In the sinus tarsi approach group, the angle of Bohler was 10° -41° , with an average of 23.5° , the angle of Gissane was 98° -141° , with an average of 120.4° . At the final follow-up, the AOFAS ankle and hind- foot score was 76-100 with an average of 91.6. The result was excellent in 29 feet, good in 17 feet, and fair in 2 feet. In the extensile lateral approach group, the angle of Bohler was 8° -44° , with an average of 24.6° , the angle of Gissane was 102° -136° , with an average of 118.3° . At the final follow-up, the AOFAS ankle and hind-foot score was 72-100 with an average of 89.4. The result was excellent in 28 feet, good in 21 feet, and fair in 3 feet. No significant difference was found between the two groups in the clinical and radiographic outcomes of the treatment for

关 键 词：跟骨骨折 骨折固定术 内 经跗骨窦入路 外侧扩大入路 

分 类 号：R687.3[医药卫生—骨科学]