两种入路内固定治疗跟骨骨折的疗效比较  

Comparison efficacy of two approaches internal fixation for treatment of calcaneal fractures

作　　者：夏臣杰 赵必允 XIA Chen-jie;ZHAO Bi-yun(Dept of Orthopaedics,Ningbo Medical Center Lihuili Hospital,Ningbo,Zhejiang 315048,China)

机构地区：[1]宁波市医疗中心李惠利医院骨科,浙江宁波315048 [2]宁波市鄞州区中西医结合医院骨科,浙江宁波315101

出　　处：《临床骨科杂志》2022年第1期128-131,共4页Journal of Clinical Orthopaedics

基　　金：国家自然科学基金面上项目(编号:81873325);浙江省中医药管理局计划项目(编号:2021ZQ082,2021ZA131)。

摘　　要：目的比较微创跗骨窦切口与传统外侧L形切口内固定治疗SandersⅡ型跟骨骨折的临床疗效。方法将38例SandersⅡ型跟骨骨折患者按手术切口不同分为微创组(20例,采用跗骨窦切口)和传统组(18例,采用传统外侧L形切口)。比较两组手术情况、影像学指标、AOFAS踝-后足功能评分及切口并发症。结果患者均获得随访,时间12~15(13.4±1.2)个月。术中出血量、手术时间及术后住院时间微创组少(短)于传统组(P<0.001)。两组末次随访跟骨长度、宽度、高度、Böhler角、Gissane角均较术前显著改善(P<0.05),但两组比较差异均无统计学意义(P>0.05)。末次随访功能优良率微创组与传统组比较差异无统计学意义(P>0.05)。术后切口并发症发生率微创组低于传统组(P<0.05)。结论传统外侧L形切口与微创跗骨窦切口内固定均能够有效治疗SandersⅡ型跟骨骨折,但微创跗骨窦切口内固定具有创伤小、距下关节暴露充分及切口并发症少等优点。Objective To compare the clinical efficacy of minimally invasive sinus tarsi approach and traditional L-shaped approach internal fixation for Sanders typeⅡcalcaneal fractures.Methods A total of 38 patients with Sanders typeⅡcalcaneal fractures were divided into minimally invasive group(20 cases were adopted with sinus tarsi approach)and traditional group(18 cases were performed with traditional lateral L-shaped approach),according to the different approaches.The operation situation,imaging indicators,AOFAS ankle-hindfoot score and incision complications were compared between two groups.Results All patients were followed up for 12~15(13.4±1.2)months.The intraoperative blood loss,operation time and postoperative hospital stay in the minimally invasive group were less(shorter)than those in the traditional group(P<0.001).At the last follow-up,the calcaneal length,width,height,Böhler angle,Gissane angle of the two groups were all significantly improved than those before operation(P<0.05),but there were no significant differences between two groups(P>0.05);the functional excellent-good rate of the minimally invasive group was similar to the traditional group(P>0.05).The incidence rate of incision complications in the minimally invasive group was less than that in the traditional group(P<0.05).Conclusions Both of minimally invasive tarsal sinus approach and the traditional lateral L-shaped approach can effectively treat Sanders typeⅡcalcaneal fractures,while minimally invasive tarsal sinus approach has the advantages of less trauma,good exposure of subtalar joint and fewer incision complications.

关 键 词：跗骨窦切口 外侧L形切口 SandersⅡ型跟骨骨折 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]