经跗骨窦间隙与外侧“L”形切口治疗SandersⅡ型跟骨骨折的疗效比较

The clinical outcomes comparison of limited open reduction via a sinus tarsi approach and open re- duction internal fixation via a lateral extensile L-shape incision for the treatment of Sanders type Ⅱ calcaneai fracture

目的评估经跗骨窦间隙有限切开及传统切开复位内固定治疗SandersⅡ型跟骨关节内骨折的近期疗效。方法2010年2月至2011年2月，筛选30例患者纳入研究，并随机分为微创组及切开组，每组15例。微创组采用经跗骨窦间隙有限切开复位内固定，切开组采用“L”形外侧扩大切口行切开复位内固定。术后拍摄X线片明确骨折愈合情况，测量BOhler角和Gissane角，记录相关并发症。采用视觉模拟评分（visualanaloguescale，VAS）、美国足踝外科协会（AmericanOrthopaedicFootandAnkleSociety，AOFAS）踝与后足评分系统及简明健康状况调查表（SF-36）综合评估最终疗效。结果微创组及切开组平均随访时间分别为16．9个月和19．9个月。切开组有2例发生皮肤切缘表皮坏死。两组病例均在术后3个月骨折愈合。术后微创组Boehler角平均13．1°±3．8°Gissane角平均28．1°±7．8°；切开组B0hler角平均14．9°±4．3°Gissane角平均26．2°±8．2°。末次随访时，微创组AOFAS和VAS评分分别为（91．2±15．9）分和（1．7±1．3）分；切开组分别为（82．4±14．7）分和（1．9±2．1）分；SF-36评分微创组[（79．5±12．1）分]优于切开组[（70．2±12．4）分]。微创组4例、切开组15例出现不同程度距下关节僵硬。结论治疗SandersⅡ型跟骨关节内骨折，两种方法近期疗效无明显差异，但采用经跗骨窦间隙有限切开术后软组织并发症发生率及距下关节僵硬率低。

Objective To evaluate the clinical outcomes of limited open reduction via sinus tarsi approach and traditional open reduction internal fixation of the treatment for Sanders type II calcaneal frac- ture. Methods Between February 2010 and February 2011, 30 patients were enrolled into our study and were divided into minimal invasive and traditional groups randomly. Each group consisted of 15 patients. When soft tissue swelling subsided, the patients of minimal invasive group were performed a limited ORIF via a sinus tarsi incision, while those traditional groups were performed ORIF via a classical lateral extensile L-shape approach. X-rays were taken in the regular follow-up, Bt^hler and Gissane angle were measured. The final curative effect was comprehensively assessed according to visual analogue scale （VAS）, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society （AOFAS） and SF-36 at the last follow-up, with the complications recorded. Results The average time of the follow-up was 16.9 months and 19.9 months respectively in two groups. Superficial skin necrosis occurred in 2 cases in traditional group. X-ray demonstrated bone union 3 months after the operation in both groups. And no implant failure occurred. The BShler angle of minimal invasive group was 13.1°±3.8° and the traditional group was 14.9°±4.3°, the Gissane angle of minimal invasive group was 28.1°±7.8° and the traditional group was 26.20°±8.2°. The average AO- FAS ankle and hindfoot score of minimal invasive group at final follow-up was 91.2±15.9, and the average VAS score was 1.7±1.3, while the traditional group was 82.4±14.7 and 1.9±2.1 respectively. But SF-36 score in minimal invasive group （79.5±12.1） was higher than that in traditional group （70.2±12.4）. Four patients in minimal invasive group and 15 in traditional group suffered from varying degrees of subtalar joint stiffness. Conclusion No significant difference was found between the two groups in the short-term efficacy of the treatment for Sanders type II calcaneal fracture. However, minimal invasive technique has the advantages of lower soft tissue complication rate and lower subtalar joint stiffness rate.