跗骨窦切口联合空心钉治疗跟骨关节内骨折

Cannulated screw fixation for closed displaced intra-articular calcaneal fractures via sinus tarsi approach

目的探讨跗骨窦切口联合空心钉治疗跟骨关节内骨折的临床效果。方法将51例跟骨关节内骨折患者按治疗方法分为两组,分别采用跗骨窦切口联合空心钉(A组,29例)与传统外侧L形切口钢板内固定(B组,22例)治疗。测量术前及末次随访时跟骨的高度、宽度、Bhler角判断骨折复位情况。采用AOFAS踝-后足评分系统评估疗效。结果 51例患者均获得随访,随访时间:A组10~17(13.19±1.47)个月,B组9~18(13.45±2.80)个月。末次随访时两组的跟骨高度、宽度、Bhler角与术前比较明显改善,差异均有统计学意义(P<0.001);两组之间比较差异无统计学意义(P>0.05)。末次随访时AOFAS评分两组比较差异无统计学意义(P>0.05)。手术并发症A组少于B组,差异有统计学意义(P<0.05)。结论跗骨窦切口联合空心钉治疗跟骨骨折有创伤小、并发症少等优点,疗效与传统外侧L形切口钢板内固定相当。

Objective To investigate the clinical outcomes of closed displaced intra-articular calcaneal fractures（ DIACFs） treated by cannulated screw fixation via sinus tarsi approach（ STA）. Methods Fifty-one patients with DIACFs were retrospectively enrolled and treated by using either STA with cannulated screw fixation（ group A,29 cases） or traditional extended lateral approach with plate fixation（ group B,22 cases）. Patients underwent a careful clinical and radiographic examination and were evaluated with the Bhler angle,height and width of calcaneus before operation and at the last follow-up. The final curative effect was assessed according to the American Orthopedic Foot and Ankle Society（ AOFAS） score criterion. Results Fifty-one patients were followed up,group A was 10 - 17（ 13. 19 ± 1. 47） months,group B was 9 - 18（ 13. 45 ± 2. 80） months. The Bhler angle,height and width of calcaneus at the last follow-up in both groups had obviously improved than those of preoperation（ P〈0. 001）,but there wasn＇t statistically significant difference between two groups（ P〈0. 05）. The AOFAS scores of two groups had no statistically significant differences（ P〉0. 05）. The group A had less incidence of wound complications than group B（ P〈0. 05）. Conclusions The STA with cannulated screw fixation is a useful method for the treatment of DIACFs,with a low incidence of complications and results comparable to those for patients treated by using the extended lateral approach with cannulated screw fixation.