两种切口内固定治疗跟骨骨折的疗效比较  

Comparison efficacy of internal fixation with two kinds of incisions for treatment of calcaneal fractures

作　　者：冯炜[1] 李俊杰[1] 吴群峰[1] 韩瑾 傅一峰[1] 杨雷[1] 俞立新[1] FENG Wei;LI Jun-jie;WU Qun-feng;HAN Jin;FU Yi-feng;YANG Lei;YU Li-xin(Dept of Orthopaedics,the 72nd Group Army Hospital of CPLA,Huzhou,Zhejiang 313000,China)

机构地区：[1]中国人民解放军陆军第七十二集团军医院骨科,浙江湖州313000

出　　处：《临床骨科杂志》2023年第3期438-442,共5页Journal of Clinical Orthopaedics

基　　金：浙江省卫健委医药卫生科技计划青年创新人才项目(编号:2022RC266)。

摘　　要：目的比较改良“八”字切口与L形切口内固定治疗跟骨骨折的疗效。方法将80例跟骨骨折患者根据手术切口不同分为A组(采用改良“八”字切口内固定治疗,40例)和B组(采用L形切口内固定治疗,40例)。记录两组术中出血量、手术时间、切口并发症、骨折愈合时间、骨痂生长评分、跟骨影像学指标和踝关节活动度。采用疼痛VAS评分评价疼痛情况,AOFAS踝-后足评分评价踝关节功能恢复情况。结果患者均获得随访,时间12~20(16.38±4.72)个月。术中出血量和手术时间A组明显短(少)于B组(P<0.01)。术后3个月骨痂生长评分、末次随访时AOFAS踝-后足评分优良率A组均明显高于B组(P<0.05)。切口并发症发生率、骨折愈合时间、末次随访时疼痛VAS评分及踝关节活动度两组比较差异均无统计学意义(P>0.05)。跟骨影像学指标:两组术后均明显优于术前(P<0.01);术后两组比较差异均无统计学意义(P>0.05)。结论改良“八”字切口与L形切口内固定治疗跟骨骨折均可获得满意效果,但改良“八”字切口内固定更具手术时间短、术中出血量少、踝关节功能恢复好的优势。Objective To compare the efficacy of the modified splayed incision and L-shaped incision for internal fixation in the treatment of calcaneal fractures.Methods According to the different surgical incisions,80 patients with calcaneal fractures were divided into group A(40 cases were treated with modified splayed incision)and group B(40 cases were treated with L-shaped incision).Intraoperative blood loss,operation time,incision complications,fracture healing time,callus growth score,radiographic indicators of calcaneus and ankle mobility were recorded.Pain was assessed using pain VAS,and ankle functional recovery was evaluated using AOFAS ankle-hindfoot score.Results All patients were followed up for 12~20(16.38±4.72)months.Intraoperative blood loss and operative time in group A were significantly shorter(less)than those in group B(P<0.01).Group A was significantly higher than group B in the callus growth score at postoperative 3 months,the excellent-good rate of AOFAS ankle-hindfoot score at the last follow-up(P<0.05).The differences in incision complication incidence rate,fracture healing time,pain VAS and ankle mobility at the last follow-up were not statistically significant between the two groups(P>0.05).Radiographic indicators of calcaneus:all data were significantly better than the preoperation in both groups(P<0.01);no statistically significant differences were found between the two groups in the postoperative period(P>0.05).Conclusions In the treatment of calcaneal fractures,both modified splayed incision and L-shaped incision for internal fixation can achieve satisfactory results,but modified splayed incision for internal fixation has the advantages of shorter operative time,less intraoperative blood loss and better functional recovery of the ankle joint.

关 键 词：跟骨骨折 微创内固定 关节内骨折 手术入路 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]