外侧横切口联合双侧撑开技术(LTBT)在SandersⅡ、Ⅲ型跟骨骨折中的应用  

Application of lateral transverse incision combined with bilateral distraction technique (LTBT) in Sanders type Ⅱ and Ⅲ calcaneal fractures

作　　者：杨虎 何知弢 钟齐刚 方家刘 詹俊锋[1] Yang Hu;He Zhitao;Zhong Qigang;Fang Jialiu;Zhan Junfeng(Department of Foot and Ankle Surgery,The Second Affiliated Hospital of Anhui Medical University,Hefei Anhui,230601,China)

机构地区：[1]安徽医科大学第二附属医院足踝外科,安徽合肥230601

出　　处：《生物骨科材料与临床研究》2023年第1期42-46,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：安徽医科大学临床科学基金(2020xkj203)。

摘　　要：目的 探讨跟骨外侧横切口联合双侧撑开技术(LTBT)处理SandersⅡ、Ⅲ型关节内跟骨骨折的临床疗效。方法 自2016年1月至2020年12月,43例患者于安徽医科大学第二附属医院接受了外侧横切口联合双侧撑开技术处理跟骨骨折。记录患者术前,术后1 d,1、3、6个月及术后1年的跟骨长度、高度、宽度及B?hler角和Gissanes角变化情况,并记录住院时间、手术时间等资料,于术前及术后1年采用VAS评分及AOFAS评分评价临床疗效。结果43例患者均获得随访,平均随访时间(14.70±1.63)个月。患者术后1 d,1、3、6个月及术后1年的跟骨长度、高度、宽度、B?hler角和Gissanes角均较术前显著改善(P<0.05)。手术时间(79.67±9.39) min。术后1年VAS评分为(0.72±1.03)分,AOFAS踝后足评分为(87.14±5.42)分,其中优13例,良28例,一般2例。且术后均未出现伤口并发症,1例患者出现腓肠神经损伤症状,2例患者出现行走后疼痛,经休息及康复理疗等处理后症状均得到改善。结论 LTBT是一种有效处理SandersⅡ、Ⅲ型跟骨骨折的手术方式。既提供了良好的手术视野,提高了解剖复位的效果,术后患者跟骨的长度、高度、宽度、B?hler角和Gissanes角均得到了明显的改善并且在末次随访中得到了良好的维持,同时降低了术后切口并发症及腓肠神经损伤的发生率。Objective To investigate the clinical effect of lateral calcaneal transverse incision combined with bilateral distraction technique(LTBT) in the treatment of Sanders type Ⅱ and Ⅲ intra-articular calcaneal fractures. Methods From January 2016 to December 2020, 43 patients received lateral transverse incision combined with bilateral distraction technique to treat calcaneal fracture in the Second Affiliated Hospital of Anhui Medical University. The changes of calcaneus length, width, height, B?hler angle and Gissanes angle before operation, and 1 d, 1, 3, 6 months after operation and 1 year after operation were recorded. The perioperative data such as hospitalization time and operation time were recorded. The clinical efficacy was evaluated by VAS score and AOFAS score before operation and 1 year after operation.Results Forty-three patients were followed up for an average of(14.70±1.63) months. The length, height, width,B?hler angle and Gissanes angle of the calcaneus were significantly improved 1 d, 1, 3, 6 months and 1 year after operation(P<0.05). The operation time was(79.67±9.39) min. One year after operation, the VAS was(0.72±1.03) scores,and the AOFAS score was(87.14±5.42) scores. Among them, 13 were excellent, 28 were good, and 2 were normal. There was no wound complications after operation. One patient had symptoms of sural nerve injury, and two patients had pain after walking. The symptoms were improved after rest and rehabilitation therapy. Conclusion LTBT is an effective method for treating Sanders type Ⅱ and Ⅲ calcaneal fractures. In addition to providing a good surgical field and improving the effect of anatomical reduction, the length, height and width of the postoperative calcaneus, B?hler angle and Gissanes angle were significantly improved and well maintained in the last follow-up, while reducing the incidence of postoperative incision complications and sural nerve injury.

关 键 词：关节内跟骨骨折 克氏针撑开器 横切口 切开复位内固定 

分 类 号：R683.42[医药卫生—骨科学]