距下关节镜辅助在Sanders Ⅱ、Ⅲ型跟骨骨折微创治疗中的应用价值分析  

Application value of subtalar arthroscopy in the minimally invasive treatment of SandersⅡandⅢcalcaneal fractures

作　　者：马国涛[1] 杨朝垒[1] 田朝奇 吴登科[1] Ma Guotao;Yang Chaolei;Tian Chaoqi;Wu Dengke(Department of Orthopedics,Pingdingshan First People’s Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]平顶山市第一人民医院骨科,河南平顶山467000

出　　处：《创伤外科杂志》2021年第9期687-690,696,共5页Journal of Traumatic Surgery

基　　金：河南省科技攻关项目(2018ZY2058)。

摘　　要：目的探讨距下关节镜辅助在SandersⅡ、Ⅲ型跟骨骨折微创治疗中的应用价值。方法前瞻性分析2018年1月—2019年6月平顶山市第一人民医院骨科收治的80例跟骨骨折患者,男性49例,女性31例;年龄18~65岁,平均39.3岁。随机数字表法分为关节镜组(40例,距下关节镜辅助踝关节外侧有限切口接骨板内固定治疗)、普通组(40例,关节外侧有限切口接骨板内固定治疗)。术后门诊随访6个月。比较两组患者手术时间、手术切口长度、术中出血量、骨折愈合时间,解剖学指标(Bohler角、Gissane角),踝关节功能(AOFAS)及术后并发症(创面感染、距关节僵硬、创伤性关节炎)发生情况。结果关节镜组手术时间(60.9±8.1)min长于普通组(54.3±7.1)min,P<0.05;手术切口长度、术中出血量与普通组对比差异均无统计学意义(P>0.05),关节镜组骨折愈合时间(11.5±1.6)周少于普通组(12.7±1.8)周,P<0.05。两组患者术前Bohler角、Gissane角水平相近(P>0.05);术后6个月Bohler角分别为(25.4±4.8)°、(24.1±4.2)°,Gissane角分别为(129.8±20.2)°、(123.8±19.3)°,相较于术前均提高(P<0.05),且两组术后Bohler角、Gissane角水平相近(P>0.05);两组患者术前AOFAS评分相近(P>0.05),术后6个月AOFAS评分分别为(87.2±15.9)分、(83.9±13.8)分,相较于术前两组AOFAS评分均提高(P<0.05),且两组AOFAS评分相近(P>0.05);关节镜组总并发症发生率(3%)低于普通组(15%),P<0.05。结论在SandersⅡ、Ⅲ型跟骨骨折微创治疗中应用距下关节镜可达到良好的复位固定,减少并发症发生率,加快患者康复。Objective To investigate the value of subtalar arthroscope in the minimally invasive treatment of SandersⅡandⅢcalcaneal fractures.Methods A total of 80 patients with calcaneal fractures admitted to Department of Orthopedics,Pingdingshan First People’s Hospital from Jan.2018 to Jun.2019 were selected as research objects.Among them,49 were males and 31 were females;their age ranged from 18 to 65 years,with an average of 39.3 years.By using the random number table method,the patients were divided into arthroscopy group(40 cases,subtalar arthroscopically assisted with the internal fixation of the bone plate with limited incision on the lateral ankle joint)and control group(40 cases,treated with the internal fixation of the bone plate with limited incision on the lateral joint).The postoperative outpatient follow-up was 6 months.The relevant rehabilitation conditions(operation time,surgical incision length,intraoperative blood loss,fracture healing time),the planimetric indexes(Bohler angle,Gissane angle),ankle joint function(AOFAS)and postoperative complications(wound infection,talar joint stiffness,traumatic arthritis)were compared between the two groups.Results The operation time of the arthroscopy group[(60.9±8.1)minutes]was longer than that of the control group[(54.3±7.1)minutes],and the difference was statistically significant(P<0.05).There was no statistical difference in the length of surgical incision and intraoperative blood loss between the two groups(P>0.05).The fracture healing time of the arthroscopic group[(11.5±1.6)weeks]was less than that of the control group[(12.7±1.8)weeks],and the difference was statistically significant(P<0.05).The preoperative Bohler and Gissane angles were similar in the two groups(P>0.05);at 6 months after operation,the Bohler angles of the two groups were(25.4±4.8)°and(24.1±4.2)°,and the Gissane angles of the two groups were(129.8±20.2)°and(123.8±19.3)°,which were both improved compared to preoperatively(P<0.05),and the levels of Bohler and Gissane angles wer

关 键 词：跟骨骨折 距下关节镜 微创 内固定 

分 类 号：R683.42[医药卫生—骨科学]