关节镜下与跗骨窦切口复位固定跟骨骨折比较  

Arthroscopic reduction and internal fixation versus the counterpart through tarsal sinus approach for calcaneal fractures

作　　者：刘子祯[1] 陈光鑫[1] 栾兆新 李正勋[2] LIU Zi-zhen;CHEN Guang-xin;LUAN Zhao-xin;LI Zheng-xun(Department of Hand-Foot Surgery and Microsurgery,The Second People's Hospital of Liaocheng City,Liaocheng Shandong 252600,China;Department of Hand and Foot Surgery,The Second Hospital,Shandong University,Jinan Shandong 250033,China)

机构地区：[1]聊城市第二人民医院手足显微外科,山东聊城252600 [2]山东大学第二医院手足外科,山东济南250033

出　　处：《中国矫形外科杂志》2024年第23期2126-2132,共7页Orthopedic Journal of China

摘　　要：【目的】比较关节镜下经皮空心螺钉与跗骨窦入路内固定治疗跟骨骨折的效果。【方法】选择2019年1月--2022年10月本院收治的跟骨骨折患者102例,抽签法随机分为两组。其中,51例采用关节镜复位经皮螺钉固定,另外51例采用跗骨窦入路复位钢板固定。比较两组围手术期、随访及辅助检查资料。【结果】关节镜组的手术时间显著长于跗骨窦组【(48.5±5.2)min vs(45.7±4.6)min,P=0.007】,但是前者切口长度【(1.6±0.5)cm vs(4.0±1.0)cm,P<0.001】、术中失血量【(10.5±3.4)ml vs(30.3±9.2)ml,P<0.001】及住院时间【(5.7±1.8)d vs(7.4±2.0)d,P<0.001】均显著优于后者。两组随访(18.2±2.6)个月,关节镜组恢复下地行走时间【(38.5±4.6)d vs(42.0±5.4)d,P<0.001】和完全负重活动时间【(65.8±6.7)d vs(70.5±8.0)d,P=0.003】均显著早于跗骨窦组。随时间推移,两组踝背伸-跖屈ROM、内-外翻ROM、AOFAS评分均显著增加(P<0.05),VAS评分显著减小(P<0.05)。术后3个月,关节镜组踝背伸-跖屈ROM、内-外翻ROM、VAS评分及AOFAS评分均显著优于踏跗骨窦组。检验方面,两组术后血清BMP-2、ICF-1水平均显著增高(P<0.05),sVCAM-1、HMGB1水平均显著下降(P<0.05)。术后3个月,关节镜组上述检验指标均显著优于跗骨窦组(P<0.05)。影像方面,两组末次随访Bohler、Gissane角均显著增加(P<0.05)。相应时间点,两组间Bohler、Gissane角及软骨塌陷的差异均无统计学意义(P>0.05)。【结论】关节镜空心螺钉内固定跟骨骨折,可显著减少手术创伤,缩短住院时间,有助于功能恢复。【Objective】To compare the clinical outcomes of arthroscopic reduction and percutaneous cannulated screw fixation versus open reduction and internal fixation(ORIF)with plate through tarsal sinus approach for calcaneal fractures.【Methods】A total of 102 pa-tients with calcaneal fracture admitted to our hospital from January 2019 to October 2022 were included into this study and randomly divid-ed into two groups by drawing lots.Among them,51 patients were treated with arthroscopic reduction and percutaneous screw fixation(the ARPSF group),while other 51 patients underwent ORIF through tarsal sinus approach(the ORIF group).The data of perioperative period,follow-up and auxiliary examination were compared between the two groups.【Results】The ARPSF group consumed significantly longer op-eration time than the ORIF group【(48.5±5.2)min vs(45.7±4.6)min,P=0.007】,but the former proved significantly superior to the latter in terms of incision length【(1.6±0.5)cm vs(4.0±1.0)cm,P<0.001】,intraoperative blood loss【(10.5±3.4)ml vs(30.3±9.2)ml,P<0.001】and length of stay【(5.7±1.8)days vs(7.4±2.0)days,P<0.001】.All patients in both groups were followed up for(18.2±2.6)months in a mean,and the ARPSF group resumed ambulation【(38.5±4.6)days vs(42.0+5.4)days,P<0.001】and full weight-bearing activity【(65.8±6.7)days vs(70.5+8.0)days,P=0.003】significantly earlier than the ORIF group.As time went on,the dorsal-plantar ankle range of motion(ROM),in-version-eversion ROM and AOFAS score were significantly increased(P<0.05),while the VAS scores were significantly decreased in both groups(P<0.05),which in the ARPSF group at 3 months after operation were significantly better than those in the ORIF group(P<0.05).As for auxiliary examination,the levels of serum BMP-2 and ICF-1 were significantly increased(P<0.05),while the levels of sVCAM-1 and HMGB1 were significantly decreased in both groups(P<0.05),which in the ARPSF group proved significantly better than those in the ORIF group 3 months after surgery(P<0

关 键 词：跟骨骨折 关节镜 空心螺钉 内固定 跗骨窦入路 钢板 

分 类 号：R683.42[医药卫生—骨科学]