跗骨窦小切口与外侧L型切口治疗跟骨骨折的对照研究

A Comparative Study of Tibial Sinus Small Incision and Lateral L Type Incision in the Treatment of Calcaneal Fractures

目的:比较跗骨窦小切口结合手法整复和跟骨外侧L型切口治疗跟骨关节内骨折的临床疗效。方法:选择2013年9月至2016年9月广州中医药大学附属骨伤科医院90例单侧跟骨骨折病人作为研究对象。将90例病人按随机数字表随机分为跗骨窦小切口结合手法整复内固定组(微创组)和外侧L型切口内固定组(常规组),统计两组患者手术等待时间、手术时间、术后切口并发症、术后第1天VAS评分,测量术前、术后及末次随访Bohler角、Gissane角,采用美国足踝外科协会(AOFAS)踝后足评分对手术效果进行评估。结果:所有患者均获得3~18个月随访,所有骨折均获得骨性愈合,微创组手术时间、术后切口并发率、术后第1天VAS评分均少于常规组,差异均有统计学意义(P<0.05)。影像学评价两组术后及末次随访Bohler角、Gissane角均较术前提高,差异有统计学意义(P<0.05),两组间差异无统计学意义(P>0.05)。SandersⅡ型骨折AOFAS踝后足评分微创组高于常规组,差异有统计学意义(P<0.05),而对于SandersⅢ型骨折常规组的AOFAS踝后足评分高于微创组,差异有统计学意义(P<0.05)。结论:跗骨窦小切口治疗SandersⅡ型及简单的SandersⅢ型跟骨骨折,临床疗效明确,值得临床推广,但对于复杂的SandersⅢ型骨折外侧L型切口仍有不可替代的优越性,因此术前应明确骨折类型,选择最佳手术入路。

Objective： To compare the clinical efficacy of tarsal sinus small incision combined with manipulative reduction and calcaneal lateral L type incision in the treatment of intra-articular calcaneal fractures. Methods： From September 2013 to September 2016, 90 patients with unilateral calcaneal fractures in orthopedics hospital affiliated to Guangzhou university of traditional Chinese medicine were chosen as the research object. They were randomly divided into tarsal sinus small incision combined with manipulative reduction and internal fixation group（minimally invasive group）and lateral L type incision fixation group（routine group）according to random number table. The time waiting for surgery, the operative time, the postoperative incisional complications, and the postoperative first day VAS score in two groups were recorded. The Bohler angle and the Gissane angle of postoperative, postoperative and last follow-up were measured. The surgical effect was evaluated by the American foot and ankle surgery association（AOFAS）ankle hind foot score. Results： All patients were followed up for 3～18 months. All fractures were bone healed. The operative time, the complication rate, and the VAS score first day after operation in minimally invasive group were lesser than the conventional group（P〈0.05）. The Bohler angle and Gissane angle in imaging evaluation of the two groups after operation and the last follow-up were significantly higher than those before the operation（P〈0.05）. There was no significant difference between the two groups after operation（P〉0.05）. The AOFAS score of ankle with Sanders type II fractures in minimally invasive group was higher than that of the conventional group（P〈0.05）. But the AOFAS score of ankle with Sanders type Ⅲ fractures in minimally invasive group was lower than the conventional group（P〈0.05）. Conclusion： Tarsal sinus small incision in the treatment of Sanders type Ⅱ and simple Sanders type Ⅲ calcaneal fractures are has an explicit clinical efficacy, and it is worthy for promotion. For complex Sanders type Ⅲ fractures, lateral L type incision still has irreplaceable superiority. Therefore, the type of fracture should be made clear before surgery and to choose the best surgical approach.