跗骨窦入路开放复位内固定累及关节跟骨骨折△

Tarsal sinus approach for open reduction and internal fixation of calcaneal fractures involving subtalar articular surface

摘要:

[目的] 探讨跗骨窦入路钢板螺钉固定累及关节跟骨骨折的疗效。[方法] 回顾性分析本院 2017 年 6 月—2020 年 6 月采用跗骨窦入路开放复位内固定累及关节面的新鲜闭合跟骨骨折 24 例患者(26 足)。评价临床及影像结果。[结果]所有患者均顺利完成手术，术中无严重并发症，手术时间平均 (53.27±2.48) min，术中出血量平均 (22.35±2.10) ml，术后切口均一期愈合。全部患者均获随访，平均随访时间(14.33±7.27)个月。末次随访，患侧踝关节主动背伸活动度及跖屈活动度均低于健侧，但差异无统计学意义 (P＞0.05)。按 AOFAS 评分评定临床结果，优 16 足，良 8 足，可 2 足，优良率为 92.31%。影像方面，与术前相比，末次随访时跟骨 B?hler 角、Gissane 角均显著增加 (P＜0.05)，跟骨宽度显著减小 (P＜0.05)，跟骨高度显著增加(P＜0.05)，跟骨长度无显著变化(P＞0.05)。[结论] 跗骨窦入路钢板螺钉固定累及关节跟骨骨折可获得良好的临床疗效。

Abstract:

[Objective] To explore the clinical outcomes of tarsal sinus approach for open reduction and internal fixation (ORIF) of cal- caneal fractures involving subtalar articular surface. [Methods] From June 2017 to June 2020, a total of 24 patients (26 feet) received ORIF with plate and screws through tarsal sinus approach for acute closed calcaneal fractures involving subtalar articular surface. The clinical and imaging results were evaluated. [Results] All patients were successfully operated on without serious complications, with operative time of (53.27±2.48) min, intraoperative blood loss of (22.35±2.10) ml, and incision healing well. At the latest follow up lasted for (14.33±7.27) months on average, both active dorsal flexion range of motion (ROM) and plantar flexion ROM on the affected side were lower than those on the healthy side, whereas which was not statistically significant (P＞0.05) . According to AOFAS score, the clinical outcome was marked as excellent in 16, good in 8 and fair in 2 feet, with the excellent and good rate of 92.31%. Radiographically, the B?hler and Gissane angles significantly increased (P＜0.05) , calcaneal width significantly decreased (P＜0.05) , calcaneal height increased significantly (P＜0.05) , whereas calcaneal length remained unchanged at the latest follow up compared with those preoperatively (P＞0.05) . [Conclusion] The tar- sal sinus approach for open reduction and internal fixation with plate and screws does achieve satisfactory clinical outcomes for calcaneal fractures involving subtalar articular surface.