两种入路开放复位内固定SandersⅡ、Ⅲ型跟骨骨折比较

Comparison of two approaches for open reduction and internal fixation of Sanders type Ⅱ and Ⅲ calcaneal fractures

摘要:

［目的］ 比较两种入路切开复位内固定 SandersⅡ、Ⅲ型跟骨骨折的临床疗效。［方法］ 回顾性研究 2018 年 1 月— 2020 年 10 月本科开放复位内定的 80 例跟骨骨折患者的临床资料。根据医患沟通结果，38 例采用跗骨窦入路，42 例采用 L 形入路。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，无神经、血管损伤等严重并发症。跗骨窦组切口长度、术中失血量、切口愈合等级、下地行走时间及住院时间均显著优于 L 形组 （P<0.05）。两组随访 （22.7±7.6） 个月， 跗骨窦组恢复完全负重活动时间显著早于 L 形组（P<0.05）。随时间推移，两组 VAS 评分均显著减少（P<0.05），而 AOFAS 评分、足内翻、外翻活动度均显著增加（P<0.05）。术后 1、6 个月及末次随访，跗骨窦组 VAS 及 AOFAS 评分均显著优于 L 形组 （P<0.05）。影像方面，术后两组 B?hler 角与 Gissane 角均较术前显著改善 （P<0.05），相应时间点，两组间 B?hler 角与 Gissane 角的差异均无统计学意义（P>0.05）。［结论］与“L”形入路相比，跗骨窦入路开放复位内固定 Sanders Ⅱ、Ⅲ型跟骨骨折具有手术创伤小，功能恢复好的优点。

Abstract:

[Objective] To compare the clinical effects of open reduction and internal fixation (ORIF) through tarsal sinus approach (TSA) versus L-shaped approach (LSA) for Sanders type Ⅱ and Ⅲ calcaneal fractures. [Methods] A retrospective study was conducted on 80 patients who underwent ORIF for calcaneal fractures in our department from January 2018 to October 2020. According to doctor-patient communication, 38 patients had ORIF performed by TSA, while the remaining 42 patients were by LSA. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups were operated on successfully without seri- ous complications such as neurovascular injuries. The TSA group proved significantly superior to LSA in terms of incision length, intraoper- ative blood loss, incision healing grade, walking time on the ground and hospital stay (P＜0.05). All the patients in both groups were fol- lowed up for (22.7±7.6) months on an average, and the TSA group resumed full weight-bearing activity significantly earlier than the LSA group (P＜0.05). The VAS score significantly decreased (P＜0.05), while the AOFAS score, varus and valgus range of motion of the foot sig- nificantly increased (P＜0.05) in both groups over time. At 1 month, 6 months postoperatively and the latest follow-up, the TSA group was significantly superior to the LSA group in terms of VAS and AOFAS scores (P＜0.05). Radiographically, the Bohler angle and Gissane an- gle were significantly improved postoperatively compared with those preoperatively in both groups (P＜0.05), whereas which were not statisti- cally significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The tarsal sinus approach for open reduc- tion and internal fixation of Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of minimizing surgical trauma and improving functional recovery over the traditional L-shaped approach.