空心钉联合跗骨窦入路与外侧L型入路钢板固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效比较  

Cannulated Screw Combined With Sinus Tarsi Approach Versus Lateral L-shaped Approach Plate Fixation for Sanders Ⅱ and Ⅲ Calcaneal Fractures

作　　者：董政麟 马捷[1] 顾剑华[1] 王祥[1] 金晨[1] 陶海荣[1] Dong Zhenglin;Ma Jie;Gu Jianhua(Department of Orthopedics,Shanghai Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine,Shanghai 200125,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海200125

出　　处：《中国微创外科杂志》2023年第7期511-516,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：国家重点研发项目(2020YFB1711505)。

摘　　要：目的探讨空心钉联合跗骨窦入路钢板固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法2016年1月~2021年2月我院分别采用空心钉联合跗骨窦入路钢板固定法或外侧L型入路钢板固定法治疗49例SandersⅡ、Ⅲ型跟骨骨折,其中空心钉联合跗骨窦入路钢板固定24例(跗骨窦入路组),外侧L型入路钢板固定25例(外侧L型入路组),比较2组手术时间、出血量、开始负重行走时间、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后并发症发生率、美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)评分、Bohler角和Gissane角矫正情况。结果所有跟骨均恢复解剖形态。跗骨窦入路组患者切口均一期愈合,未发生并发症,外侧L型入路组5例皮肤愈合不良,跗骨窦入路组并发症发生率显著低于外侧L型入路组(Fisher精确检验,P=0.028)。跗骨窦入路组手术时间(t=-4.775,P=0.000),出血量(t=3.370,P=0.000),开始负重行走的时间(t=-2.277,P=0.027),疼痛VAS评分(t=-2.128,P=0.039),AOFAS评分(t=8.578,P=0.000)均显著优于外侧L型入路组。跗骨窦入路组与外侧L型入路组术后6个月Bohler角(t=1.360,P=0.180)和Gissane角(t=0.441,P=0.661)无显著性差异。结论空心钉联合跗骨窦入路钢板固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折,复位效果好,创伤小,并发症少。Objective To analyze clinical effect of cannulated screw combined with sinus tarsi approach plate fixation in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Methods A total of 49 patients with Sanders Ⅱ and Ⅲ calcaneal fractures who were admitted to our hospital from January 2016 to February 2021 were retrospectively studied.There were 24 patients treated with cannulated screw combined with sinus tarsi approach plate fixation(study group)and 25 patients treated with lateral L-shaped approach plate fixation(control group).The operation time,blood loss,time to start weight-bearing walking,visual analogue scale(VAS),incidence of postoperative complications,American Orthopedic Foot and Ankle Society(AOFAS)score,B hler angle and Gissane angle were observed and compared between the two groups.Results The calcaneus recovered to anatomical shape in all the cases.The wounds of the patients in the study group healed up by first intention without other complications,while there were 5 cases of poor skin healing in the control group.The incidence of complications in the study group was significantly lower than that in the control group(Fisher’s exact test,P=0.028).The operation time(t=-4.775,P=0.000),blood loss(t=3.370,P=0.000),time to start weight-bearing walking(t=-2.277,P=0.027),VAS score(t=-2.128,P=0.039)and AOFAS score(t=8.578,P=0.000)in the study group were significantly better than those in the control group.There were no significant differences in B hler angle(t=1.360,P=0.180)and Gissane angle(t=0.441,P=0.661)between the study group and the control group at 6 months after operation.Conclusion Cannulated screw combined with sinus tarsi approach plate fixation in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures has good reduction effect,less trauma and fewer complications.

关 键 词：SandersⅡ型跟骨骨折 SandersⅢ型跟骨骨折 跗骨窦入路 外侧L型入路 

分 类 号：R687.3[医药卫生—骨科学]