跗骨窦切口辅助Ilizarov技术与切开复位内固定治疗SandersⅢ、Ⅳ型跟骨骨折的疗效比较  

Comparison of Ilizarov Technique Assisted by Tarsal Sinus Incision and Open Reduction and Internal Fixation in the Treatment of Sanders TypeⅢandⅣCalcaneal Fractures

作　　者：余兰伟[1] 张祝辉 邱华骥[1] 王清玉[1] 陈妍[1] 李良华[1] 韩大为[1] YU Lan-wei;ZHANG Zhu-hui;QIU Hua-ji;WANG Qing-yu;CHEN Yan;LI Liang-hua;HAN Da-wei(The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350004)

机构地区：[1]福建中医药大学附属人民医院,福州350004

出　　处：《实用中西医结合临床》2021年第8期1-5,128,共6页Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine

基　　金：福建省教育厅中青年教师教育科研项目(科技类)(编号:JAT190257)。

摘　　要：目的:探讨跗骨窦切口辅助Ilizarov技术治疗SandersⅢ、Ⅳ型跟骨骨折的疗效。方法:回顾性分析2013年6月~2019年12月治疗的40例(45足)SandersⅢ、Ⅳ型跟骨骨折患者资料,微创外架组16例(17足)采用跗骨窦切口辅助Ilizarov技术治疗,切开钢板组24例(28足)采用经外侧“L”形切口切开复位钢板内固定术治疗。对比两组的手术相关时间及出血量、手术前后的影像学变化和术后的患足功能、生活质量、疼痛情况。结果:至末次随访时,所有病例达到骨性愈合,微创外架组平均愈合时间(11.77±3.13)周,切开钢板组平均愈合时间(12.02±2.97)周,差异无统计学意义(P>0.05)。术前两组患者的健侧、患侧影像学测量结果对比,差异无统计学意义(P>0.05)。术后切开钢板组Bohler角、Gissane角优于微创外架组,差异有统计学意义(P<0.05)。微创外架组轴位角、跟骨长度、足跟宽度优于切开钢板组,差异有统计学意义(P<0.05)。微创外架组等待手术时间、止血带时间、手术时间、出血量均比切开钢板组少,差异有统计学意义(P<0.05)。微创外架组美国足踝外科协会踝-后足评分、疼痛评分、并发症发生率与切开钢板组比较,差异无统计学意义(P>0.05)。微创外架组健康调查简表SF-36评分较切开钢板组高,差异有统计学意义(P<0.05)。结论:跗骨窦切口辅助Ilizarov技术治疗SandersⅢ、Ⅳ型跟骨骨折可取得与切开复位内固定相似的疗效,是治疗难复性跟骨关节内骨折的一种良好选择。Objective:To investigate the clinical effect of Ilizarov technique assisted by tarsal sinus incision in the treatment of Sanders typeⅢandⅣcalcaneal fractures.Methods:The data of 40 patients(45 feet)with Sanders typeⅢandⅣcalcaneal fractures treated from June 2013 to December 2019 were retrospectively analyzed.In the minimally invasive external fixation group,16 cases(17 feet)were treated with Ilizarov technique through tarsal sinus incision,while in the open plate group,24 cases(28 feet)were treated with open reduction and plate internal fixation through lateral“L”incision.The operative time,the amount of blood loss,imaging changes before and after operation,postoperative foot function,the quality of life and the pain were compared between the two groups.Results:At the last follow-up,all cases were achieved bone healing,the average healing time of minimally invasive external fixation group was(11.77±3.13)weeks;the average healing time of open plate group was(12.02±2.97)weeks,there was no significant difference(P>0.05).There was no significant difference in the imaging measurement results of the healthy side and the affected side between the two groups before operation(P>0.05).Bohler Angle and Gissane Angle in the open plate group were better than those in the minimally invasive external fixation group,and the difference was statistically significant(P<0.05).Axial Angle,calcaneal length and heel width in the minimally invasive external fixation group were better than those in the open plate group,with statistical significance(P<0.05).The waiting time,tourniquet time,operation time and blood loss of minimally invasive external fixation group were less than those of open plate group,the difference was statistically significant(P<0.05).There were no significant differences in the American Association of Food and Ankle Surgeons Ankle-Hindfoot Score,pain score and complication rate between in the minimally invasive external fixation group and in the open plate group(P>0.05).The score of SF-36 in the health

关 键 词：跟骨骨折 ILIZAROV技术 跗骨窦切口 切开复位钢板内固定术 

分 类 号：R687.3[医药卫生—骨科学]