中国修复重建外科杂志

中国修复重建外科杂志

改良跗骨窦入路治疗 Sanders 型跟骨骨折疗效分析

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目的探讨改良跗骨窦入路与传统跗骨窦入路治疗 SandersⅡ~Ⅲ 型跟骨骨折的近期临床疗效。方法选取 2015 年 1 月—2017 年 8 月符合选择标准的 53 例 SandersⅡ~Ⅲ 型跟骨骨折患者,采用随机数字法将患者分为观察组(21 例,采用从腓骨长短肌腱下方暴露距下关节后对骨折复位的改良跗骨窦入路)和对照组(32 例,采用传统跗骨窦入路)。两组患者性别、年龄、侧别、致伤原因、骨折分型、受伤至手术时间以及术前 Böhler 角、Gissane 角、疼痛视觉模拟评分(VAS)等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术后引流量、手术相关并发症,术后 Böhler 角、Gissane 角及术后角度改善值;并使用 VAS 评分、美国矫形足踝协会(AOFAS)踝与后足评分及简明健康调查量表(SF-36 量表)评价疗效。结果53 例患者均顺利完成手术,无血管神经损伤、围手术期死亡等严重并发症。两组患者手术时间及术后引流量比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间 12~36 个月,平均 17 个月。术后未发生骨折移位、内固定失败、骨折畸形愈合等;所有患者均未行二期关节融合手术。两组骨折愈合时间比较差异无统计学意义(t=0.30,P=0.77)。两组术后 2 d Böhler 角、Gissane 角均较术前显著改善(P<0.05);但观察组术后 2 d Böhler 角、Gissane 角及改善值与对照组比较差异均无统计学意义(P>0.05)。两组术后 24 h 及 1 年 VAS 评分均较术前显著改善(P<0.05);术后 24 h 及 1 年两组 VAS 评分比较差异均无统计学意义(P>0.05)。两组术后 1 年 AOFAS 评分比较差异无统计学意义(t=1.46,P=0.15);但观察术后 1 年 SF-36 量表评分显著高于对照组(t=2.08,P=0.04)。末次随访时,观察组 2 例、对照组 8 例患者出现距下关节僵硬或疼痛,两组发生率比较差异无统计学意义(χ2=1.98,P=0.16)。结论采用改良跗骨窦入路治疗 SandersⅡ~Ⅲ 型跟骨骨折,具有创伤小、直视下复位清晰、复位固定可靠、切口并发症少等优点。

ObjectiveTo investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures.MethodsBetween January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative Böhler angle, Gissane angle, visual analogue scale (VAS) core (P>0.05), which were comparable. The operation time, postoperative drainage volume, postoperative Böhler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness.ResultsAll the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups (P>0.05). Patients in both groups were followed up 12-36 months (mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups (t=0.30, P=0.77). The postoperative Böhler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation (P<0.05); however, there was no significant difference in Böhler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation (P>0.05). VAS score at 24 hours and 1 year after operation was significantly improved when compared with that before operation in both groups (P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation (P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation (t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group (t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups (χ2=1.98, P=0.16).ConclusionThe modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of small trauma, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.

关键词: 跟骨骨折; 跗骨窦入路; 微创

Key words: Calcaneal fracture; tarsal sinus approach; minimally invasive

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