经跗骨窦小切口与经皮撬拨治疗SandersⅡ、Ⅲ型骨折的比较  

Comparison of Minimal Sinus Tarsi Approach and Percutaneous Poking Approach for Sanders TypeⅡorⅢCalcaneal Fractures

作　　者：李景光 章平治 徐名洪 徐宏光 杨学明[1] Li Jingguang;Zhang Pingzhi;Xu Minghong(Department of Orthopaedics, First Affiliated Hospital of Anhui College of Traditional Chinese Medicine, Wuhu 241000, China)

机构地区：[1]安徽中医药高等专科学校附属医院骨科,芜湖241000 [2]皖南医学院弋矶山医院骨科,芜湖241000

出　　处：《中国微创外科杂志》2020年第12期1100-1105,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：安徽省高校自然科学研究重点项目(KJ2019A1090)。

摘　　要：目的探讨经跗骨窦小切口(sinus tarsi approach,STA)与经皮撬拨(percutaneous poking approach,PPA)治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法回顾性分析2016年1月~2018年12月应用空心螺钉固定治疗闭合性SandersⅡ、Ⅲ型骨折63例(69足)资料,其中经STA复位31例34足;PPA复位32例35足。比较2组手术时间、住院时间、骨折愈合时间、跟骨宽度、Böhler角、Gissane角、CT后关节面复位质量及术后并发症;采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分系统评价疗效。结果2组术后均未出现伤口并发症或深部感染,术后3个月骨折均愈合。2组住院时间、随访时间差异无统计学意义(P>0.05)。与PPA组比较,STA组手术时间短[(51.9±10.6)min vs.(88.0±21.8)min,t=-8.705,P=0.000],后关节面骨折复位质量为优的占比高[94.1%(32/34)vs.65.7%(23/35),χ^2=8.603,P=0.003],AOFAS评分高[(91.1±5.9)分vs.(83.5±7.7)分,t=4.555,P=0.000]。2组AOFAS优良率差异无统计学意义[94.1%(32/34)vs.77.1%(27/35),χ^2=2.757,P=0.097]。2组术后3 d跟骨宽度、Gissane角、Böhler角均较术前显著改善,STA组改善更明显(P<0.05)。末次随访,STA组距下关节僵硬2足,创伤性关节炎1足,并发症发生率为8.8%(3/34);PPA组距下关节僵硬7足,创伤性关节炎4足,腓侧撞击综合征2足,并发症发生率37.1%(13/35)。STA组并发症少于PPA组(χ^2=7.765,P=0.005)。结论与经皮撬拨比较,跗骨窦小切口治疗SandersⅡ、Ⅲ型骨折关节面复位好,并发症发生率低,同样可避免切口并发症。Objective To investigate clinical results of minimal sinus tarsi approach(STA)and percutaneous poking approach(PPA)for Sanders typeⅡorⅢcalcaneal fractures.Methods The clinical data of 63 cases(69 feet)of fresh and closed calcaneal fractures treated with cannulated screws from January 2016 to December 2018 were retrospectively analyzed.There were 31 cases(34 feet)in the STA group and 32 cases(35 feet)in the PPA group.The duration of surgery,hospitalization stay,fracture healing time,calcaneal width,Böhler and Gissane angle,reduction quality of Posterior facet in CT scanning,postoperative complications as well as the American Orthopaedic Foot and Ankle Society(AOFAS)score were assessed and compared between the two groups.Results No wound problem happened and all the fractures healed within 3 months in both groups.The hospitalization stay and follow-up duration had no significant difference between the two groups(P>0.05).As compared to the PPA group,the STA group had shorter operation time[(51.9±10.6)min vs.(88.0±21.8)min,t=-8.705,P=0.000],better reduction quality of posterior facet[94.1%(32/34)vs.65.7%(23/35),χ^2=8.603,P=0.003]and higher AOFAS scores[(91.1±5.9)points vs.(83.5±7.7)points,t=4.555,P=0.000].There was no significant difference in the excellent and good rate of AOFAS score between the two groups[94.1%(32/34)vs.77.1%(27/35),χ^2=2.757,P=0.097].The calcaneus width,Gissane angle and Böhler angle at 3 days after operation were improved in each group as compared with those of preoperation,and these changes occurred in the STA group were more obvious than those in the PPA group(P<0.05).At the final follow-up,2 feet of subtalar joint stiffness and 1 foot of traumatic arthritis occurred in the STA group,while 7 feet of subtalar joint stiffness,4 feet of traumatic arthritis and 2 feet of peroneal tenosynovitis occurred in the PPA group,showing significant difference(χ^2=7.765,P=0.005).ConclusionCompared with percutaneous poking approach for treating Sanders typeⅡorⅢcalcaneal fractures,minimal sinu

关 键 词：跟骨骨折 跗骨窦小切口 

分 类 号：R68[医药卫生—骨科学]