经跗骨窦入路钢板内固定治疗合并糖尿病的Sanders Ⅱ、Ⅲ型跟骨骨折患者的临床观察  

Clinical observation of internal fixation with tarsal sinus plate in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures with diabetes mellitus

作　　者：刘森 陆峰 魏书婷 王豪 莫凡 LIU Sen;LU Feng;WEI Shu-ting(Department of Orthopedics and Traumatology,Guidong People's Hospital of Guangxi Zhuang Autonomous Region,Wuzhou Guangxi 543000,China)

机构地区：[1]广西壮族自治区桂东人民医院骨伤科,广西梧州543000 [2]广东省揭阳市中医院骨科,广东揭阳522000 [3]广西医科大学附属埌东医院骨科,广西南宁530028

出　　处：《临床和实验医学杂志》2025年第1期45-50,共6页Journal of Clinical and Experimental Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费项目(编号:Z20210646)。

摘　　要：目的 探讨经跗骨窦入路钢板内固定治疗合并糖尿病的SandersⅡ、Ⅲ型跟骨骨折患者的临床应用效果。方法 前瞻性选取2019年5月至2022年5月广西壮族自治区桂东人民医院收治的56例合并糖尿病的SandersⅡ、Ⅲ型跟骨骨折患者为研究对象。按照随机数字表法将其分为对照组(28例30足)和观察组(28例32足)。对照组以传统切开复位内固定术治疗,观察组采用经跗骨窦入路钢板内固定术治疗。比较两组患者的手术指标(手术时间、术中出血量、术中透视次数、切口愈合时间、住院时间、骨折愈合时间),评估两组患者的足踝功能优良率,观察两组患者的术后并发症发生情况,术前、术后12个月的骨折处影像学指标(B9hler角、Gissane角、跟骨高度、跟骨长度)、炎症因子指标[白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、Toll样受体4(TLR4)]。结果 观察组手术时间、术中出血量、术中透视次数、切口愈合时间、住院时间、骨折愈合时间均少(短)于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为3.57%,低于对照组(28.57%),差异有统计学意义(P<0.05)。术后12个月,两组的各影像学指标均较治疗前显著升高,且观察组的各影像学指标分别为(39.13±4.84)°、(135.43±12.36)°、(49.13±4.93) mm、(85.83±4.66) mm,均高于对照组[(34.16±4.65)°、(126.01±11.90)°、(44.54±4.43) mm、(82.09±3.79) mm],差异均有统计学意义(P<0.05)。术后12个月,两组的IL-6、TNF-α、TLR4水平均较术前降低,且观察组IL-6、TNF-α、TLR4水平分别为(42.76±5.22)、(68.83±8.04)、(17.43±3.76) ng/mL,均低于对照组[(49.04±5.94)、(76.41±8.83)、(21.82±4.99) ng/mL],差异均有统计学意义(P<0.05)。结论 经跗骨窦入路钢板内固定治疗合并糖尿病的SandersⅡ、Ⅲ型跟骨骨折的效果良好,可缩短手术时间,促进骨折愈合,降低术后并发症发生率,改善骨折处影像学指标,降低炎症因�Objective To study the clinical effect of internal fixation with tarsal sinus plate in the treatment of SandersⅡandⅢcalcaneal fractures with diabetes mellitus.Methods A total of 56 patients with SandersⅡandⅢcalcaneal fractures with diabetes mellitus admitted to Guidong People's Hospital of Guangxi Zhuang Autonomous Region from May 2019 to May 2022 were prospectively selected as the research objects.According to the random number table method,they were divided into the control group(28 cases,30 feet)and the observation group(28 cases,32 feet).The control group was treated with traditional open reduction and internal fixation surgery,while the observation group was treated with steel plate internal fixation surgery through the tarsal sinus approach.The operation indexes(operation time,intraoperative blood loss,intraoperative fluoroscopy times,incision healing time,hospitalization time,fracture healing time)of the two groups were compared.The excellent and good rate of foot and ankle function of the two groups was evaluated.The postoperative complications of the two groups were observed.The imaging indexes(B hler angle,Gissane angle,calcaneal height,calcaneal length)and inflammatory factor indexes[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),Toll-like receptor 4(TLR4)]of the fracture site before and 12 months after operation were observed.Results The operation time,intraoperative blood loss,intraoperative fluoroscopy times,incision healing time,hospitalization time and fracture healing time of the observation group were less(shorter)than those of the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 3.57%,which was lower than that in the control group(28.57%),and the difference was statistically significant(P<0.05).At 12 months after operation,the imaging indexes of the two groups were significantly higher than those before treatment,and the B hler angle,Gissane angle,calcaneal height,calcaneal lengt of the observation

关 键 词：骨折 跟骨 跗骨 糖尿病 SandersⅡ、Ⅲ型 经跗骨窦入路 钢板内固定 手术效果 

分 类 号：R68[医药卫生—骨科学]