经跗骨窦入路小切口空心螺钉内固定治疗跟骨骨折相关角度变化  

Changes of related angles in calcaneal fractures treated with cannulated screw internal fixation via a small incision sinus tarsi approach

作　　者：刘铁成 王大麟[1] LIU Tie-cheng;WANG Da-lin(First Department of Orthopedics,Affiliated Hospital of Beihua University,Jilin Jilin 132000,China)

机构地区：[1]北华大学附属医院骨一科,吉林吉林132000

出　　处：《局解手术学杂志》2025年第1期49-54,共6页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的 探讨跟骨骨折患者经跗骨窦入路小切口空心螺钉内固定治疗对跟骨相关角度的影响。方法 选择2020年6月至2023年7月在我院手术治疗的跟骨骨折患者107例作为研究对象,根据治疗方式不同分为A组(n=56,采用外侧L形切口结合钢板内固定)和B组(n=51,采用跗骨窦入路小切口空心螺钉内固定)。比较2组患者手术前后Bohler角、Gissane角、跟骨宽度、跟骨高度、美国矫形外科足踝协会(AOFAS)Maryland足功能评分、视觉模拟量表(VAS)评分。Pearson法分析手术前后各影像学指标间及与Maryland足功能评分、VAS评分间的相关性,以及手术前后影像学指标差值与Maryland足功能评分、VAS评分改善率间的关系。结果 2组患者术后Bohler角、Gissane角、跟骨宽度、跟骨高度均较术前显著改善(P<0.05)。B组患者术后1个月Bohler角小于A组(P<0.05),术后3个月和6个月Bohler角、术后3个月Gissane角和跟骨宽度大于A组(P<0.05)。2组患者术后1、3、6个月的VAS评分均较术前显著降低(P<0.05),Maryland足功能评分均较术前显著增加(P<0.05)。B组患者术后1、3、6个月Maryland足功能评分和VAS评分均明显优于A组(P<0.05)。手术前后Bohler角、跟骨宽度、Gissane角、跟骨高度间均相关(P<0.05);术前跟骨宽度、跟骨高度与Maryland足功能评分、VAS评分无关(P>0.05),术前Bohler角、Gissane角与Maryland评分及VAS评分相关(P<0.05);术后Bohler角、跟骨宽度、Gissane角、跟骨高度均与Maryland足功能评分及VAS评分相关(P<0.05)。Bohler角、Gissane角、跟骨宽度、跟骨高度手术前后差值与Maryland足功能评分、VAS评分改善率间均具有相关性(P<0.05)。结论 经跗骨窦入路小切口空心螺钉内固定治疗跟骨骨折后,Bohler角、Gissane角与跟骨高度均增加,跟骨宽度减小,疗效优于外侧L形切口结合钢板内固定治疗。Bohler角、Gissane角、跟骨宽度和跟骨高度的变化与临床疗效具有相关性。Objective To investigate the effect of cannulated screw internal fixation via a small incision sinus tarsi approach on calcaneal related angles in patients with calcaneal fractures.Methods A total of 107 patients with calcaneal fractures who were treated in our hospital from June 2020 to July 2023 were selected,and they were divided into the group A(n=56,underwent lateral L-shaped approach combined with steel plate internal fixation) and group B(n=51,underwent cannulated screw internal fixation via a small incision sinus tarsi approach).The Bohler angle,Gissane angle,calcaneal width,calcaneal height,American Orthopaedic Foot and Ankle Association(AOFAS) Maryland foot function score,and visual analogue scale(VAS) score before and after surgery were compared between the two groups.The correlations between the imaging data before and after surgery,their correlation with the AOFAS Maryland foot function score and VAS score,and the correlations between the difference in imaging indexes before and after surgery and the improvement rates of Maryland foot function score and VAS score were analyzed by Pearson method.Results The Bohler angle,Gissane angle,calcaneal width,and calcaneal height after surgery in both groups were significantly improved compared with those before surgery(P<0.05).The group B had smaller Bohler angle 1 month after surgery,and greater Bohler angle 3 months and 6 months after surgery,and Gissane angle and calcaneal width 3months after surgery compared with those in group A(P<0.05).At 1,3,and 6 months after surgery,the VAS scores of both groups were significantly reduced compared with those before surgery(P<0.05),while the Maryland foot function scores were significantly increased compared with those before surgery(P<0.05).The Maryland foot function scores and VAS scores 1,3,and 6 months after surgery of the group B were significantly better than those of the group A(P<0.05).The Bohler angle,calcaneal width,Gissane angle,and calcaneal height were all correlated before and after surgery(P<0.05);before

关 键 词：跟骨骨折 Bohler角 Gissane角 经跗骨窦入路 空心螺钉内固定 外侧L形切口结合钢板内固定 

分 类 号：R683.4[医药卫生—骨科学]