手法复位结合经跗骨窦入路微创治疗跟骨骨折20例  

20 Cases of Calcaneal Fracture Treated by Manual Reduction Combined with Minimally Invasive Operation through Tarsal Sinus Approach

作　　者：吴毛[1] 胡钢[1] 严松鹤[1] 梁杰 汪志炯[1] 俞云飞[1] WU Mao;HU Gang;YAN Songhe;LIANG Jie;WANG Zhijiong;YU Yunfei(Department of Orthopedics,Wuxi Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Wuxi 214071,Jiangsu China)

机构地区：[1]江苏无锡市中医医院,江苏无锡214071

出　　处：《中国中医骨伤科杂志》2021年第12期54-56,60,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:观察手法复位结合经跗骨窦入路微创治疗跟骨骨折的临床疗效。方法:对2015年3月至2020年6月收治的SandersⅡ型、SandersⅢ型跟骨骨折患者,在手法闭合复位的基础上,采用经跗骨窦入路结合微型钢板及空心螺钉进行固定治疗。采用对比术前、术后及随访时跟骨解剖参数和Maryland评分等进行临床疗效评价。结果:20例患者均获得6~12个月随访,平均随访9.5个月。跟骨长度术前为(69.54±2.71)mm,术后2周为(72.84±2.33)mm,末次随访为(72.69±1.93)mm;跟骨宽度术前为(35.31±2.16)mm,术后2周为(31.25±2.41)mm,末次随访为(30.82±2.61)mm;跟骨高度术前为(33.34±1.95)mm,术后2周为(38.33±1.88)mm,末次随访为(38.13±1.92)mm;跟骨Gisanes角术前为98.09°±5.03°,术后2周为123.66°±2.47°,末次随访为122.62°±3.16°;跟骨B9hler角术前为8.10°±4.31°,术后2周为28.36°±3.79°,末次随访为26.05°±3.48°;Maryland评分术前为(53.25±13.19)分,末次随访为(85.95±11.79)分,手术前后差异有统计学意义(P<0.05)。结论:手法复位结合经跗骨窦入路微创治疗跟骨骨折的临床疗效确切,具有创伤小、并发症少等优势,为部分跟骨骨折患者提供了一种安全有效的微创方法。Objective:To observe the clinical efficacy of manual reduction combined with minimally invasive operation through tarsal sinus approach on the treatment of calcaneal fracture.Methods:Patients with Sanders Ⅱ and Sanders Ⅲ calcaneal fractures from March 2015 to June 2020 were treated by fixation through the tarsal sinus approach combined with mini-plate and hollow screw based on manual closed reduction. The clinical efficacy was evaluated by comparing calcaneal anatomical parameters and Maryland score before, after and during follow-up.Results:All 20 patients were followed up for 6 to 12 months, with an average of 9.5 months. The calcaneal length was(69.54±2.71) mm before operation,(72.84±2.33) mm 2 weeks after operation and(72.69±1.93) mm at the last follow-up. Calcaneal width was(35.31±2.16) mm before operation,(31.25±2.41) mm 2 weeks after operation and(30.82±2.61) mm at the last follow-up. Calcaneal height was(33.34±1.95) mm before operation,(38.33±1.88) mm 2 weeks after operation and(38.13±1.92) mm at last follow-up. Calcaneal Gisanes angle was 98.09°±5.03° before operation, 123.66°±2.47° 2 weeks after operation and 122.62°±3.16° at last follow-up. Calcaneal Bohler angle was 8.10°±4.31° before operation, 28.36°±3.79° 2 weeks after operation, and(26.05°±3.48°) at the last follow-up. Maryland score was 53.25±13.19 before operation and 85.95±11.79 at last follow-up. The difference had statistically significant before and after operation.Conclusion:The trans-tarsal sinus approach combined with manual reduction for the minimally invasive treatment of calcaneal fracture has the advantages of precise clinical efficacy, small trauma and fewer complications, providing a safe and effective minimally invasive method for some patients with calcaneal fracture.

关 键 词：跟骨骨折 跗骨窦切口 微创钢板内固定 伤口并发症 

分 类 号：R683.42[医药卫生—骨科学]