经跗骨窦小切口与L形切口治疗Sanders Ⅱ、Ⅲ、Ⅳ型跟骨骨折疗效比较

Comparison of the curative effect of Sanders type Ⅱ,Ⅲ and Ⅳ calcaneal fracture treated with the tarsal sinus small incision and the L-shape incision

目的比较经跗骨窦小切口与L形切口复位内固定治疗Sanders Ⅱ、Ⅲ、Ⅳ型跟骨骨折的临床疗效。方法将80例患者按治疗方法不同分为治疗组和对照组,治疗组采用经跗骨窦小切口治疗(40例,42足),对照组采用传统L形切口治疗(40例,44足)。比较两组手术时间、术中出血量、住院时间、术后并发症、手术前后B9hler角和Gissane角、末次随访时Maryland足功能评分。结果患者均获得随访,时间15～24个月。治疗组手术时间、术中出血量、住院时间均少于对照组,差异均有统计学意义(P<0.05)。术后Bhler角和Gissane角、末次随访时Maryland足功能评分两组比较差异均无统计学意义(P>0.05)。两组均无骨髓炎、骨不连、关节面再次塌陷等并发症;治疗组未发生伤口感染及皮肤坏死;对照组发生伤口感染2例、部分皮瓣坏死4例、伤口裂开2例;两组术后并发症比较差异有统计学意义(P<0.05)。结论经跗骨窦小切口治疗跟骨骨折是一种微创、简捷、安全的手术方式。

Objective To compare the curative effect of Sanders type Ⅱ,Ⅲ and Ⅳ calcaneal fractures treated with the tarsal sinus small incision and the L-shape incision. Methods The 80 patients were divided into trial group and control group according to therapeutic methods,trial group was treated by the tarsal sinus small incision（ 40 patients,42 feet）,the control group was treated by the L-shape incision（ 40 patients,44 feet）. Operative time,intraoperative blood loss,hospitalization time,postoperative complications,Bhler angle and Gissane angle before and after operation,Maryland foot function score at the last follow-up were compared between the two groups. Results All patients were followed up for 15 ～ 24 months. The operative time,intraoperative blood loss and hospitalization time of the trial group were less than those of the control group,the differences were statistically significant（ P〈0.05）. There were no significant differences in Bhler angle and Gissane angle after operation,Maryland foot function scores at the last follow-up between two groups（ P〉0.05）. There were no osteomyelitis,bone nonunion,repeated collapse of the articular surface and other complications in the two groups. None of wound infection or skin necrosis occurred in the trial group. In the control group,there were 2 cases of wound infection,4 cases of partial skin flap necrosis and 2 cases of wound dehiscence. There was significant difference in the postoperative complications between the two groups（ P〈0.05）. Conclusions Calcaneal fractures treated by open reduction and internal fixation with the tarsal sinus small incision is a minimally invasive,simple,safe way.