关节镜辅助下经跗骨窦切口内固定治疗跟骨关节内骨折

Arthroscopically assisted internal fixation with tarsal sinus incision for calcaneal fracture

目的 探讨关节镜辅助下经跗骨窦切口内固定治疗跟骨关节内骨折的手术方法和疗效。方法 自2011-07—2013-06对52例跟骨关节内骨折在关节镜辅助下经跗骨窦切口切开复位钢板内固定治疗。术前及术后第3天常规摄跟骨轴位、侧位X线片,并测量跟骨高度、宽度、长度以及Bohler、Gissane角。末次随访时采用AOFAS评分系统对踝-足部功能进行评估。结果 52例均获得随访,随访时间9-15个月,平均12个月。所有患者术后复查X线片提示骨折复位满意,术后第3天跟骨高度、宽度、长度以及Bohler、Gissane角较术前明显改善,差异有统计学意义（P〈0.05）。除1例切口延迟愈合外,其余患者切口均一期愈合。末次随访时AOFAS评分：SandersⅡ型优10例,良5例;SandersⅢ型优12例,良14例,可1例;SandersⅣ型优3例,良4例,可2例,差1例。结论 对于跟骨关节内骨折,采用关节镜辅助下经跗骨窦切口切开复位钢板内固定更加接近解剖复位,足部功能恢复满意且术后皮肤坏死等并发症发生率较低。

Objective To explore the method and effect of operation for the treatment of intra-articular calcaneal fractures with arthroscopically assisted internal fixation with tarsal sinus incision.Methods From July 2011 to June 2013,52 cases of intra-articular calcaneal fractures were treated with arthroscopically assisted internal fixation with tarsal sinus incision.Before and on the third day after operation,the conventional radiography of the axial,lateral X-ray were taken,and the height,width,length and Gissane,Bohler angle of the calcaneus were measured.At the end of the follow-up,the AOFAS score system was used to evaluate the function of the ankle and foot.Results All cases were followed up for 9-15 months,average 12 months.X-ray films were taken in all patients after operation,and the height,width,length and Gissane and Bohler angle on third day after operation were significantly improved,and the difference was statistically significant（P〈0.05）.Except for 1 case of delayed healing,the rest of the patients got wound healing in the first stage.At the end of the follow-up,the AOFAS score were taken,for Sanders type Ⅱ：excellent in 10 cases,good in 5 cases,for Sanders type Ⅲ：excellent in 12 cases,good in 14 cases,general in 1 case,for Sanders type Ⅳ：excellent in 3 cases,good in 4 cases,fair in 2 cases,poor in 1 case.Conclusion For intra-articular calcaneal fracture,arthroscopically assisted open reduction and plate internal fixation with incision of the tarsal sinus is more close to anatomical reduction,foot function gets recovered satisfactorily and postoperative complications such as skin necrosis occurrence rate are low.