两种入路开放复位内固定Sanders II~III跟骨骨折△

Two approaches for open reduction and internal fixation of Sanders II~III calcaneal fractures

摘要:

［目的］比较跗骨窦入路与外侧 L 形入路开放复位内固定 Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效。［方法］回顾性分析 2018 年 7 月—2021 年 8 月手术治疗的 Sanders Ⅱ、Ⅲ型跟骨骨折患者 40 例（44 足）的临术资料。根据术前医患沟通结果， 21 足采用跗骨窦入路结合埋头螺钉及微创锁定接骨板（跗骨窦组），23 足采用传统外侧 L 形入路结合跟骨解剖锁定接骨板（L 形组）。比较两组围手术期、随访及影像结果。［结果］跗骨窦组手术时间、切口长度、术中出血量以及住院时间均显著少于 L 形组（P<0.05）。两组患者术中透视次数及术后下地行走时间的差异无统计学意义（P>0.05）。40 例患者随访 12 个月以上，两组术后完全负重活动时间的差异无统计学意义（P>0.05）。随术后时间推移，两组 VAS 评分显著减少（P<0.05），AOFAS 踝-后足评分、足内-外翻 ROM 均显著增加（P<0.05）。术后第 1 d 跗骨窦组 VAS 评分显著小于 L 形组（P<0.05）、术后 6 个月及末次随访时两组 VAS 评分的差异均无统计学意义（P>0.05），相应时间点，两组 AOFAS 踝-后足评分、足内-外翻 ROM 的差异均无统计学意义（P>0.05）。影像方面，与术前相比，两组术后即刻及末次随访时 Gissane 角、B?hler 角、跟骨长度及宽度均显著改善 （P<0.05）；相应时间点，两组上述影像指标的差异均无统计学意义（P>0.05）。［结论］相较于传统外侧 L 形入路锁定解剖钢板固定，经跗骨窦入路微创锁定接骨板联合埋头螺钉治疗 Sanders Ⅱ、Ⅲ型跟骨骨折具有手术时间短、术中出血量少、切口小、并发症少等优点。

Abstract:

[Objective] To compare the clinical efficacy of tarsal sinus approach (TSA) versus lateral L- shaped approach (LLA) for open reduction and internal fixation (ORIF) of Sanders Ⅱ and Ⅲ calcaneal fractures. [Methods] A retrospective study was done on 40 pa- tients (44 feet) who received ORIF for Sanders type Ⅱ and Ⅲ calcaneal fractures from July 2018 to August 2021. According to the results of preoperative doctor-patient communication, 21 feet received ORIF with headless screws and minimally invasive locking plate through the TSA, while the remaining 23 feet were treated with ORIF by anatomic locking plate through traditional LLA. The perioperative period, follow- up and imaging documents were compared between the two groups. [Results] The TSA group proved significantly superior to the LLA group in terms of operation time, incision length, intraoperative blood loss and hospital stay (P＜0.05), regardless of the fact that there were no statistically significant differences in terms of intraoperative fluoroscopy times and postoperative walking time between the two groups (P＞0.05). All 40 patients were followed up for more than 12 months without a significant difference in the time to resume fullweight-bearing activities between the two groups (P＞0.05). The VAS scores decreased significantly (P＜0.05), while the AOFAS ankle-hind- foot score and foot inversion-eversion range of motion (ROM) increased significantly in both groups over time postoperatively (P＜0.05). The TSA group was significantly better than the LLA group in VAS scores 1 day after surgery (P＜0.05), whereas which became not significant different between the two groups at 6 months and the latest follow-up (P＞0.05). In addition, there were no significant differences in AOFAS ankle-hindfoot score and inversion- eversion ROM between the two groups at any corresponding time points (P＞0.05). Regarding to imag- ing evaluation, the Gissane angle, Bohler angle, calcaneal length and width significantly improved in both groups immediately after surgery and at the latest follow-up compared with those preoperatively (P＜0.05), whereas which proved not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The ORIF with headless screw and minimally invasive locking plate through tarsal sinus approach has the advantages of shortening operation time, reducing intraoperative bleeding, incision length and compli- cations over the traditional counterpart with anatomic locking plate through the lateral L-shaped approach for treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures