不同手术入路内固定方式在Sanders Ⅲ型跟骨骨折患者中的应用观察  

Application of Different Surgical Approaches of Internal Fixation in Patients with Sanders TypeⅢCalcaneal Fractures

作　　者：李林武 扈克治 吕波 任磊 康艳宾 LI Lin-wu;HU Ke-zhi;LYU Bo;REN Lei;KANG Yan-bin(Department of Traumatology and Orthopedics,the People's Hospital of Guilin,Guilin,Guangxi 541002,China)

机构地区：[1]桂林市人民医院创伤骨科,广西壮族自治区桂林541002

出　　处：《临床误诊误治》2020年第12期60-65,共6页Clinical Misdiagnosis & Mistherapy

基　　金：广西壮族自治区卫生和计划生育委员会科研课题(z2017194)。

摘　　要：目的探讨经皮撬剥复位固定、跗骨窦入路螺钉固定、扩大外侧入路钢板固定在SandersⅢ型跟骨骨折患者中的应用效果。方法选取2017年8月—2018年12月本院收治的SandersⅢ型跟骨骨折患者135例,根据治疗方法的不同分为A、B、C组各45例,A组行经皮撬剥复位固定,B组行跗骨窦入路螺钉固定,C组行扩大外侧入路钢板固定。比较3组住院时间、术中出血量、手术时间及切口愈合时间,术前及术后7 d美国足踝外科学会(AOFAS)评分及骨折愈合情况,术前及术后7 d跟骨结节关节角(Bohler角)、跟骨交叉角(Gissane角)、跟骨宽度、根骨高度和术后7 d并发症发生情况。结果A、B组手术时间、切口愈合时间及住院时间较C组短,术中出血量少于C组,差异均有统计学意义(P<0.01)。术后7 d 3组Bohler角及Cissane角均大于术前,跟骨高度及跟骨宽度均低于术前,差异有统计学意义(P<0.05或P<0.01)。术后7 d 3组AOFAS评分均高于术前(P<0.01),3组术后骨折愈合优良率比较差异无统计学意义(P>0.05)。A、B组术后7 d总并发症发生率均低于C组(P<0.05)。结论经皮撬剥复位固定、跗骨窦入路螺钉固定、扩大外侧入路钢板固定治疗SandersⅢ型跟骨骨折效果相当,但经皮撬剥复位固定及跗骨窦入路螺钉固定较扩大外侧入路钢板固定能缩短手术时间、切口愈合时间及住院时间,减少术中出血量及降低术后并发症发生率。Objective To explore the application effect of percutaneous prying reduction and fixation,screw fixation via the tarsal sinus approach,plate fixation via expanded lateral approach in patients with Sanders typeⅢcalcaneal fractures.Methods A total of 135 patients with Sanders typeⅢcalcaneal fractures that were treated between August 2017 and December 2018 in our hospital were enrolled,and divided into group A(n=45),group B(n=45),and group C(n=45)according to different treatment methods.Group A underwent percutaneous prying reduction and fixation,group B underwent screw fixation via the tarsal sinus approach,and group C underwent plate fixation via expanded lateral approach.Length of hospitalization,intraoperative blood loss,duration of surgery and incision healing time,American Academy of Foot and Ankle Surgery(AOFAS)score and fracture healing before operation and at 7 d after surgery,calcaneal tuberosity joint angle(Bohler angle),calcaneal cross angle(Gissane angle),calcaneal width,root bone height before surgery and at 7 d after surgery and complications at 7 d after surgery were compared among the three groups.Results The duration of surgery,incision healing time and duration of hospital stay of group A and group B were shorter than those of group C,and the intraoperative blood loss was less than that of group C(P<0.01).Bohler Angle and Cissane Angle of the three groups at 7 d after surgery were greater than those before surgery,and calcaneal height and calcaneal width were lower than those before surgery(P<0.05 or P<0.01).AOFAS scores of the three groups at 7 d after surgery were higher than those before surgery(P<0.01),and there was no statistically significant difference in the excellent and good rate of postoperative fracture healing among the three groups(P>0.05).The incidence of postoperative complications at 7 d after surgery was lower in group A and group B than in group C(P<0.05).Conclusion The percutaneous prying reduction and fixation,screw fixation via the tarsal sinus approach,plate fixation via

关 键 词：骨折 跟骨 经皮撬剥复位固定术 跗骨窦入路螺钉固定术 扩大外侧入路钢板固定 手术时间 手术后并发症 

分 类 号：R683[医药卫生—骨科学]