跟骨外侧骨皮瓣入路与传统L形入路治疗Sanders Ⅲ～Ⅳ型跟骨骨折的比较

Lateral bone flap approach compared to traditional lateral L-shaped approach for Sanders Ⅲ-Ⅳ type calcaneal fractures

目的比较跟骨外侧骨皮瓣入路与传统L形入路切开复位内固定治疗SandersⅢ~Ⅳ型跟骨骨折,术后切口并发症、临床功能及影像学结果。方法 2013年2月—2015年2月46例患者纳入本研究,根据手术入路不同将患者分为骨外侧皮瓣入路组(23例)和传统L形入路组(23例),比较两组患者切口并发症、骨折愈合时间、临床功能、跟骨宽度、Gissane角及B9ohler角。结果 46例均获得随访,骨皮瓣入路组随访时间12~36个月,平均24.7个月,传统入路组随访时间12~36个月,平均22.3个月,两组患者随访时间差异无统计学意义(P>0.05)。骨外侧皮瓣入路组1例(4.4%)出现切口浅表感染1例;传统入路组8例(34.8%),其中出现皮缘坏死4例、切口部分裂开2例、浅表感染2例,两组患者切口并发症发生率比较,差异有统计学意义(P<0.05)。两组患者在住院天数、骨折愈合时间、临床功能、跟骨宽度、Gissane角及B9ohler角等方面的差异无统计学意义(P>0.05)。结论对于SandersⅢ~Ⅳ型跟骨骨折,采用跟骨外侧骨皮瓣入路与传统L形入路行切开复位内固定术治疗,均可获得满意的临床疗效与影像学结果,但前者术后切口并发症发生率较低。

Objective To compare wound complications,clinical function and radiographic results between lateral bone flap approach and traditional lateral l-shaped approach for sanders Ⅲ-Ⅳ type calcaneal fractures.Methods A total of 46 patients were treated by open reduction and internal fixation between Feb. 2013 to Feb.2015. These patients were divided to bone flap approach group（ lateral bone flap approch for fracture,n = 23） and traditional approach group（ traditional lateral L-shaped approach for fracture,n = 23） according to different approach. Data was compared between the two groups,including length of hospital stay,wound complications,time of fracture union,clinical function,width of the calcaneal,Bohler＇s angle,and Gissane＇s angle. Results All of 46 patients were followed up,and the mean follow-up in bone flap approach group and traditional approach group was24. 7（ 12-36） months and 22. 3（ 12-36） months,respectively. There was no significant difference in follow-up time between two groups（ P〉0. 05）. There was 1（ 4. 3%） patient with wound complication（ superficial infection） in bone flap approach group,and 8（ 34. 7%） patients with wound complication（ 4 patients with skin flap necrosis,2with incision dehiscence and 2 with superficial infection） in traditional approach group. There was significant difference in rate of wound complication between two groups（ P〈0. 05）. However,there was no significant difference between two groups in term of the length of hospital stay,time of fracture union,clinical function,width of the calcaneal,B9hler＇s angle,and Gissane＇s angle（ P〉0. 05）. Conclusion Both bone flap approach and traditional approach for the Sanders Ⅲ-Ⅳ Type calcaneal fractures can achieve satisfactory clinical function and radiographic results,but the bone flap approach has the advantage of low wound complication rate.