两种微创术式治疗Sanders Ⅱ型和Ⅲ型跟骨骨折比较  

Comparison of two minimally invasive techniques for Sanders Type Ⅱ and Ⅲ calcaneal fractures

作　　者：庞伟强 邓明明 杜瑞[1] 付炳金[1] 孙广超[1] 刘颖[1] PANG Wei-qiang;DENGMing-ming;DU Rui;FU Bing-jin;SUN Guang-chao;LIU Ying(Department of Foot and Ankle Surgery,Affiliated Hospital,Binzhou Medical College,Binzhou,Shandong 256603,China)

机构地区：[1]滨州医学院附属医院足踝外科,山东滨州256603

出　　处：《中国矫形外科杂志》2025年第4期311-317,共7页Orthopedic Journal of China

摘　　要：[目的]比较跗骨窦入路接骨板内固定与闭合复位经皮螺钉固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效。[方法]回顾性分析2019年7月—2022年1月收治的43例Sanders Ⅱ、Ⅲ型跟骨骨折患者的临床资料。根据医患沟通结果,23例行跗骨窦入路切开复位接骨板固定(跗骨窦组),20例行闭合复位经皮螺钉固定(经皮组)。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术。跗骨窦组手术时间[(81.7±12.7)min vs(71.9±13.9)min,P=0.020]、切口长度[(5.6±1.1)cm vs(1.9±0.6)cm,P<0.001]、术中失血量[(56.7±26.8)mL vs(14.1±8.7)m L,P<0.001]、住院时间[(7.3±2.0)d vs(5.5±1.4)d,P<0.001]及切口愈合等级[例,甲/乙/丙,(17/3/3)vs(20/0/0),P=0.048]均不及经皮组;但跗骨窦组术中透视次数显著少于经皮组[(7.1±2.6)次vs(10.4±2.7)次,P<0.001]。两组患者随访(18.7±5.9)个月,术后随时间推移,两组的VAS评分、AOFAS评分、足内-外翻ROM均显著改善(P<0.05)。术后1个月,跗骨窦组的足内-外翻ROM[(30.9±5.6)°vs(40.0±4.5)°,P<0.001]显著小于经皮组。影像方面,与术前相比,术后即刻与末次随访时,两组患者B?hler角、Gissane角、跟骨长度、跟骨宽度、跟骨高度均显著改善。末次随访时,跗骨窦组B?hler角[(29.1±1.6)°vs(27.3±1.8)°,P<0.001]、跟骨高度[(45.9±2.3)mm vs(43.7±2.3)mm,P=0.003]均显著优于经皮组。术后6个月与末次随访时,跗骨窦组软骨面塌陷[(1.4±0.7)mm vs(2.5±1.1)mm,P<0.001;(2.0±1.2)mm vs(4.1±1.6)mm,P<0.001]显著优于经皮组。[结论]两种术式均是治疗Sanders Ⅱ、Ⅲ型跟骨骨折的有效方式,相比之下,闭合复位螺钉固定具有微创优势,而跗骨窦切开复位接骨板固定维持骨折稳定性更好,固定强度更为可靠。[Objective]To compare the clinical efficacy of open reduction and internal fixation with plate through tarsal sinus approachversus closed reduction and percutaneous screw fixation for Sanders type Ⅱ and Ⅲ calcaneal fractures.[Methods]A retrospective analysiswas performed on 43 patients who had Sanders type Ⅱ and Ⅲ calcaneal fractures treated surgically from July 2019 to January 2022.According to doctor-patient communication,23 patients were treated with open reduction and plate fixation through tarsal sinus approach(thetarsal sinus group),while other 20 patients underwent closed reduction and percutaneous screw fixation(percutaneous group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had operation completed successfully.The sinus tarsi group consumed significantly longer operation time[(81.7±12.7)min vs(71.9±13.9)min,P=0.020],with significantlygreater incision length[(5.6±1.1)cm vs(1.9±0.6)cm,P<0.001],more intraoperative blood loss[(56.7±26.8)mL vs(14.1±8.7)mL,P<0.001],the hospital stay[(7.3±2.0)days vs(5.5±1.4)days,P<0.001]and poorer incision healing grade[A/B/C,(17/3/3)vs(20/0/0),P=0.048]than the percutaneous group,whereas the former had significantly less intraoperative fluoroscopy times than the latter[(7.1±2.6)times vs(10.4±2.7)times,P<0.001].The patients in both groups were followed up for(18.7±5.9)months in a mean,and the VAS,AOFASscores,as well as inversion-eversion ROM in both groups were significantly improved over time(P<0.05).The tarsal sinus group had significantly less inversion-eversion ROM than the percutaneous group 1 month postoperatively[(30.9±5.6)°vs(40.0±4.5)°,P<0.001].Regardingimaging,the Bohler angle,Gissane angle,calcaneus length,calcaneus width,and calcaneus height were significantly improved in bothgroups immediately after surgery and at the last follow-up compared with those preoperatively.At the last follow-up,the tarsal sinus groupproved significantly better than the percutaneous group in terms

关 键 词：跟骨骨折 跗骨窦入路 开放复位内固定 闭合复位 经皮螺钉固定 

分 类 号：R683.42[医药卫生—骨科学]