经跗骨窦入路与外侧L型入路治疗跟骨骨折的疗效比较

Comparison of the Therapeutic Effect of the Tarsal Sinus Approach and the Lateral L-shaped Approach in the Treatment of Calcaneal Fracture

目的:比较经跗骨窦入路与外侧L型入路治疗跟骨骨折的临床疗效。方法:选取2013年9月—2016年8月本院采用跗骨窦入路(跗骨窦组,31例)与外侧L型入路(外侧L型组,30例)切开复位钢板内固定治疗的跟骨骨折病例资料进行回顾性分析,对两组受伤至手术前天数、手术时间、术中出血量、术后并发症、影像学指标及术后功能情况进行比较。结果:61例患者随访时间12~18个月,平均(15. 3±3. 5)月。跗骨窦组手术前天数、手术时间和术中出血量少于外侧L型组(P <0. 05),且无早晚期并发症;外侧L型组发生局部皮肤坏死5例,创伤性关节炎1例,腓肠神经损伤1例。随访两组功能、末次随访影像学表现组间无统计学差异。结论:采用经跗骨窦入路微创治疗跟骨骨折可以取得满意的骨折复位及固定效果,其相关切口并发症的发生率远低于经外侧L型入路。

Objective ：To compare the clinical effect of the tarsal sinus approach and the lateral L- shaped approach in the treatment of calcaneal fracture. Methods：A retrospective analysis of 61 cases of calcaneal fractures treated with tarsal sinus approach（31 cases of tarsal sinus group） and lateral L - shaped approach（ 30 cases of lateral L - shaped approach） with open reduction and internal fixation was performed from September 2013 to August 2016. To compare the number of days before injury to the number of days before surgery, operation time, intraoperative blood loss, postoperative complications, imaging parameters and postoperative function. Results ：61 cases were followed up, the average time of 12 - 18 months, （ 15.3 ± 3.5 ） months after the operation. The number of days before the operation time, operation time and bleeding volume in the tarsal sinus group was lower than the lateral L - shaped approach group （P 〈 0. 05 ） , and no early and late complications in the tarsal sinus group. There were 5 cases of local skin necrosis, 1 case of traumatic arthritis and 1 case of sural nerve injury in the lateral L - shaped group. There was no statistical difference between the two groups in the follow - up imaging and the last follow - up imaging findings. Conclusion： Minimally invasive treatment of calcaneal fractures through the tarsal sinus approach can achieve satisfactory reduction and fixation effect, and the incidence of related incision complications is far lower than the lateral lateral ＂ L＂ approach.