跗骨窦与关节镜入路治疗Sanders Ⅱ/Ⅲ型跟骨骨折  

Tarsal sinus approach versus arthroscopic approach for internal fixation of Sanders typeⅡ/Ⅲcalcaneal fractures

作　　者：杨坚[1] 陶高鑫 李琪[1] 戴毅 YANG Jian;TAO Gao-xin;LI Qi;DAI Yi(The First Affiliated Hospital,Medical College,Shihezi University,Shihezi 832000,China;Hospital of Seven Agricultural Division,Xinjia ng Construction Regiment.,Shihezi 833200,China)

机构地区：[1]新疆石河子大学医学院第一附属医院,832000 [2]新疆兵团市农七师医院,833200

出　　处：《中国矫形外科杂志》2020年第12期1063-1067,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81302304)。

摘　　要：[目的]比较跗关节镜入路与跗骨窦入路内固定治疗SandersⅡ/Ⅲ型跟骨骨折的临床效果。[方法] 2015年7月~2018年9月本院手术治疗的45例(52足)跟骨骨折患者。依据手术入路将患者分为两组,关节镜组21例(23足),跗骨窦组24例(29足)。比较两组患者的围手术期、随访和影像资料。[结果]所有患者均顺利完成手术。关节镜组手术时间显著长于跗骨窦组(P<0.05)。关节镜组无神经损伤,跗骨窦组2例患者发生腓浅神经损伤。跗骨窦组4例发生皮缘坏死及浅表感染,经换药治疗后感染均控制。两组患者随访14~18个月,关节镜组下地行走时间和完全负重活动时间显著早于跗骨窦组(P>0.05)。随术后时间推移,两组患者VAS评分显著减少,而AOFAS评分显著增加(P<0.05)。术后1周,关节镜组VAS评分显著小于跗骨窦组(P<0.05),术后2个月及末次随访,关节镜组AOFAS评分显著大于跗骨窦组(P<0.05),其他相应时间点两组间VAS和AOFAS评分的差异均无统计学意义(P>0.05)。影像方面,术后关节镜组的Bohler角、跟骨长度、宽度均显著优于跗骨窦组,差异有统计学意义(P<0.05),而Gissane角两组间差异无统计学意义(P>0.05)。[结论]关节镜治疗SandersⅡ/Ⅲ型跟骨骨折能够提高跟骨的复位质量,显著减少手术切口并发症,但学习曲线较长。[Objective]To compare the clinical outcomes of tarsal sinus approach versus arthroscopic approach for internal fixation of Sanders type Ⅱ/Ⅲ calcaneal fractures.[Methods]A retrospective study was conducted on 45 patients(52 feet)who under reduction and internal fixation for Sanders type Ⅱ/Ⅲ calcaneal fractures from July 2015 to September 2018 in our hospital.In term approach applied,21 patients(23 feet)had reduction and internal fixation accomplished through arthroscopic approach,while the other 24 patients(29 feet)had operation performed through tarsal sinus approach.The perioperative,followup and radiographic documents were compared between the two groups.[Results]All the patients in both groups had operation done smoothly.The arthroscopic group consumed significantly longer operation time than the tarsal sinus group(P<0.05).Superficial peroneal nerve injury occurred in 2 patients of tarsal sinus group,whereas no one in the arthroscopic group,additionally,superficial skin necrosis and infection happened in 4 patients of the tarsal sinus group,which eventually healed after corresponding therapy.As time went in follow-up period lasted for 14~18 months,the VAS score significantly decreased,whereas the AOFAS score significantly increased in both group(P<0.05).The arthroscopic group was significantly superior to the tarsal sinus group in VAS score at first week postoperatively and AOFAS score at 2 months and the last follow-up after operation(P<0.05),although there were no statistical differences in the VAS and AOFAS score between the two group at remaining matching time points(P>0.05).In term of radiographic assessment,the arthroscopic group proved significantly superior to the tarsal sinus group regarding to Bohler angle,calcaneus length and width postoperatively(P<0.05),regardless of no statistical difference in Gissane angle between them after operation(P>0.05).[Conclusion]Arthroscopic treatment for Sanders Ⅱ/Ⅲ calcaneal fractures has advantages of improving fracture reduction quality and reducing inc

关 键 词：跟骨骨折 跗骨窦入路 关节镜 内固定 

分 类 号：R683.42[医药卫生—骨科学]