经跗骨窦微创切口治疗跟骨骨折的临床疗效分析

Analysis on the clinical effect of minimally invasive incision via tarsal sinus in the treatment of calcaneal fractures

目的探讨经跗骨窦微创切口松质骨螺钉加自制小钢板内固定治疗跟骨骨折的临床疗效。方法将我科收治并需要手术治疗的跟骨骨折患者随机分为微创组和对照组,每组30例。骨折类型按Sanders分型标准。微创组患者采用经跗骨窦微创切口松质骨螺钉加自制小钢板内固定治疗(Ⅱ型16例、Ⅲ型10例、Ⅳ型4例);对照组采用经传统"L"形切口复位钢板螺钉内固定治疗(Ⅱ型14例、Ⅲ型9例、Ⅳ型7例)。观察两种方法治疗前后患足功能的恢复情况,评定治疗的优良率。结果经7~18个月随访,患者均获得骨性愈合。两种患者治疗后跟骨长度、宽度、高度、Bohler角、Gissane角及优良率比较,差异均无统计学意义(P>0.05)。微创组患者切口均甲级愈合,对照组有5例出现伤口延迟愈合,经伤口换药后约4~8周伤口愈合。结论经跗骨窦微创切口松质骨螺钉加自制小钢板内固定治疗跟骨骨折具有创伤小、术后固定可靠,软组织并发症少等优点,是治疗跟骨骨折的良好选择。

Objective To investigate the clinical effect of minimally invasive incision via the tarsal sinus with cancellous bone screw and self-made small plate internal fixation in the treatment of calcaneal fractures. Methods The patients with calcaneal fractures who were admitted and treated in our department and were in need of surgery were randomly divided into two groups： minimally invasive group and control group, with 30 cases in each group. The types of fractures were according to Sanders classification. The patients in the minimally invasive group were given minimally invasive incision via tarsal sinus with cancellous bone screw and self-made small plate internal fixation（Type Ⅱ 16 cases, type Ⅲ 10 cases, type Ⅳ 4 cases）; the control group was given traditional ＂L＂ shaped incision reduction plate internal fixation（type Ⅱ 14 cases, type Ⅲ 9 cases, type Ⅳ 7 cases）. The recovery of affected feet before and after the treatment by the two methods were observed. The excellent and good rate of the treatment was evaluated. Results After 7 months to 18 months follow-up visits, the patients all acquired bone healing. There were no statistically significant differences in length,width,height of root bone,Bohler angle, Gissane angle and excellent and good rate between the two groups after treatment（P0.05）. The patients in the minimally invasive group all acquired grade A healing. In the control group, 5 cases had delayed wound healing. After wound dressing, the wound was healed after about 4 to 8 weeks.Conclusion Minimally invasive incision via the tarsal sinus with cancellous bone screw and self-made small plate internal fixation in the treatment of calcaneal fractures has the advantages of small trauma, reliable fixation after the surgery, and few soft tissue complications, which is a good choice for the treatment of calcaneal fractures.