经跗骨窦入路钢板内固定结合切口负压封闭吸引治疗跟骨关节内骨折的研究

Treatment of intra-articular calcaneal fractures with steel plate internal fixation by the sinus tarsi approach combined with vacuum sealing drainage

目的随访观察经跗骨窦入路钢板内固定结合切口负压封闭吸引治疗跟骨关节内骨折的临床疗效及术后切口并发症情况。方法选择2014年10月—2016年3月温州医科大学附属第二医院收治的38例患者,共40足跟骨关节内骨折。38例患者均大于18周岁,SandersⅡ、Ⅲ、Ⅳ型闭合性跟骨关节内骨折,无合并同侧足踝部其他骨折及严重的软组织损伤,无合并糖尿病或下肢血管性疾病,无明显软组织感染或皮肤疾病。该组病例均在受伤后4~12 d,平均6.5 d,行经跗骨窦入路钢板内固定结合切口负压封闭吸引。观察术前术后及末次随访时跟骨的B9hler角,Gissane角、跟骨长度、宽度、高度的变化,末次随访的Maryland足部评分,以及切口感染等术后并发症。结果全部38例患者经过12~24个月的随访,平均随访时间15.5个月,术后B9hler角、Gissane角、跟骨长度、跟骨宽度及跟骨高度分别为32.820°±5.770°,116.500°±8.000°,(71.045±7.487)mm,(27.642±2.115)mm,(40.306±4.520)mm,末次随访情况分别32.270°±5.234°,115.900°±7.801°,(72.270±6.813)mm,(27.212±2.483)mm,(39.833±4.598)mm,Maryland足部评分优良率为80.25%,术后无一例发生切口愈合不良、浅表或深部感染。结论经跗骨窦入路能很好暴露距下关节面,恢复跟骨B9hler角、Gissane角、跟骨长度、跟骨宽度及跟骨高度,结合切口负压封闭吸引能更好的避免切口感染并发症,并减少早期换药次数,减轻患者的痛苦和临床医生的负担。

Objective To observe the clinical effect and postoperative incision complications of patients with intra-articular calcaneal fractures by steel plate internal fixation by the tarsal sinus approach combined with vacuum sealing drainage.Methods Total 38 patients with 40 foots with intra-articular calcaneal fractures were admitted in our hospital. All patients aged over 18 years old,and were with closed Sanders Ⅱ,Ⅲ,Ⅳ type intra-articular fracture,without severe soft tissue trauma in ipsilateral ankle,without diabetes and lower extremity vascular disease. All patients were treated with steel plate internal fixation by the tarsal sinus approach combined with vacuum sealing drainage in 4-12 days after injury. We observed the B9 hler angle,Gissane angle,length of calcaneus,width of calcaneus,height of calcaneus of pre-operation,post-operation and final follow-up,Maryland score of foot at final follow-up,and the postoperative complications.Results All 38 patients were followed up for 12-24 months,the mean follow-up was 15. 5 months,the B9 hler angle,Gissane angle,length of calcaneus,width of calcaneus,and height of calcaneus of post-operation was（ 32. 82 ± 5. 77） °,（ 116. 50 ± 8. 00） °,（ 71. 05 ± 7. 49） mm,（ 27. 64 ± 2. 12） mm and（ 40. 31 ± 4. 52） mm,respectively,while the final follow-up was（ 32. 27 ± 5. 23） °,（ 115. 90 ± 7. 80） °,（ 72. 27 ± 6. 81） mm,（ 27. 21 ± 2. 48） mm and（ 39. 83 ± 4. 60）mm,respectively. The excellent and good rate was 80. 25%. There was no wound complication. Conclusion With good exposure of the subtalar joint by the tarsal sinus approach,the B9 hler angle,Gissane angle,length of calcaneus,width of calcaneus and height of calcaneus could be regained. The vacuum sealing drainage can avoid wound infection complications better,reduce the times of change dressing,and alleviate the sufferings of the patient and the burden of clinical doctors.