经跗骨窦小切口空心钉固定治疗跟骨骨折疗效观察  

Curative effect of minimally invasive internal fixation with cannulated screws through tarsal sinus in the treatment of calcaneal fracture

作　　者：卢洋 王瑜[1] 李征宇[1] 姬钢[1] LU Yang;WANG Yu;LI Zheng-yu;JI Gang(First Department of Orthopedics,Xi'an Central Hospital,Xi'an 710003,Shaanxi,CHINA)

机构地区：[1]西安市中心医院骨一科

出　　处：《海南医学》2019年第21期2771-2774,共4页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:2019SF-229)

摘　　要：目的观察经跗骨窦小切口空心钉固定治疗跟骨骨折的临床疗效。方法回顾性分析2016年1月至2018年1月于西安市中心医院骨一科接受治疗的90例跟骨骨折患者的临床资料,按照治疗方式不同分为观察组和对照组,每组45例。对照组使用传统外侧“L”形切口钢板固定实施手术,观察组使用经跗骨窦小切口空心钉固定实施手术。比较两组患者的围术期指标、Bohler角、Gissane角、根骨中部宽度,以及Maryfand评分的优良率和并发症发生情况。结果观察组和对照组患者的术中出血量[(46.76±8.50)mL vs(65.49±12.14)mL]、手术时间[(81.38±16.34)min vs(106.51±23.71)min]、住院时间[(6.21±1.77)d vs(8.06±2.21)d]和骨折愈合时间[(12.02±1.89)周vs(14.47±2.10)周]比较,观察组明显少于或短于对照组,差异均有统计学意义(P<0.05);手术后即刻,两组患者的Bohler角、Gissane角、根骨中部宽度比较差异均无统计学意义(P>0.05);随访一年结果显示,观察组患者的Maryfand评分优良率为91.11%,明显高于对照组的75.56%,差异有统计学意义(P<0.05);观察组患者的切口感染、距下关节炎、跟腓撞击症总发生率为6.67%,明显低于对照组的22.22%,差异有统计学意义(P<0.05)。结论经跗骨窦小切口空心钉固定治疗跟骨骨折可有效帮助骨折复位,且具有创伤小、术后恢复快、并发症发生率等优点,临床治疗效果显著,值得推广应用。Objective To study the curative effect of minimally invasive internal fixation with cannulated screws through tarsal sinus in the treatment of calcaneal fracture.Methods The clinical data of 90 patients of calcaneal fracture treated in Department of Orthopedics,Xi'an Central Hospital from January 2016 to January 2018 were retrospectively analyzed,which were divided into observation group and control group according to different treatment methods,with 45 patients in each group.The control group applied traditional extended lateral“L-shape”incision with plate fixation,while the observation group employed minimally invasive internal fixation with cannulated screws through tarsal sinus.The perioperative indicators,Bohler angle,Gissane angle,width of middle calcaneus,Maryfand score,and complications were compared between the two groups.Results The intraoperative blood loss,operation time,hospitalization time,and healing time of fracture in the observation group were significantly less or shorter than those in the control group(P<0.05):(46.76±8.50)mL vs(65.49±12.14)mL;(81.38±16.34)min vs(106.51±23.71)min;(6.21±1.77)vs(8.06±2.21)d;(12.02±1.89)weeks vs(14.47±2.10)weeks.After operation immediately,the Bohler angle,Gissane angle,and width of middle calcaneus showed no significant difference between the two groups(P>0.05).The one-year follow-up showed that the excellent and good rate of the Maryfand score in the observation group was 91.11%,which was significantly higher than 75.56%in the control group(P<0.05).The total incidence of incision infection,subtalar arthritis,and calcaneofibular impingement in the observation group were 6.67%,which were significantly lower than 22.22%in the control group(P<0.05).Conclusion Minimally invasive internal fixation with cannulated screws through tarsal sinus for treating calcaneal fracture can effectively help fracture reduction,and has the advantages of minimal trauma,quick recovery after operation and low incidence of complications,which is worth popularizing.

关 键 词：跗骨窦 空心钉 内固定 跟骨骨折 并发症 

分 类 号：R683.42[医药卫生—骨科学]