跗骨窦联合外侧纵形切口与传统外侧L型切口治疗Sanders Ⅱ型跟骨骨折的比较研究

Comparison of sinus tarsi approach and lateral L-shaped incision for the treatment of Sanders type Ⅱ calcaneal fractures

目的比较跗骨窦联合外侧纵形切口与传统外侧L型切口行切开复位内固定治疗SandersⅡ型跟骨骨折的疗效,探讨更为合理有效的手术入路方式。方法纳入2014年1月—2015年1月湖州市第一人民医院骨科收治的40例SandersⅡ型单侧闭合性跟骨骨折患者,根据切口方式不同分为观察组及对照组,每组20例;观察组采用跗骨窦联合外侧纵形切口,对照组采用传统外侧L型切口。比较两组患者的年龄、坠落高度、伤后至手术时间,以及跟骨术前、术后及末次随访的B9hler角和Gissane角,并采用Maryland足功能评分、健康调查简表(SF-36)比较两组的临床疗效。结果两组在年龄、坠落高度、伤后至手术时间等方面差异无统计学意义(P>0.05)。观察组术后平均随访时间为(13.4±2.0)个月,均未出现相关切口并发症;对照组术后平均随访时间为(14.3±2.4)个月,早期出现皮缘坏死及切口红肿渗出各1例;两组末次随访时均获得临床骨性愈合。两组术后B9hler角和Gissane角同术前相比均显著改善,差异有统计学意义(P<0.05)。末次随访时观察组Maryland评分、SF-36评分为(82.6±11.8)、(82.6±7.2)分,对照组为(81.1±12.9)、(79.7±8.8)分,两组比较差异无统计学意义(P>0.05)。结论跗骨窦联合外侧纵形切口可以取得同外侧L型切口相似的临床疗效,但其对切口软组织保护较好,且发生距下关节僵硬的概率较低。

ObjectiveTo investigate a more reasonable and effective surgical approach for the surgery of Sanders typeⅡcalcaneal fracture,by comparing the treatment between sinus tarsi approach combined with lateral longitudinal approach and traditional lateral L type incision.MethodsForty patients with unilateral Sanders typeⅡcalcaneal fracture were recruited from Jan.2014to Jan.2015,and were randomly divided into observation group and control group,with20cases in each group.The baseline information including age,falling height,interval time from injury to operation was collected.All patients in the observation group were performed open reduction and internal fixation(ORIF)using sinus tarsi approach combined with lateral longitudinal approach,and patients in the control group was treated by lateral L type incision.The Bhler angle and Gissane angle before and after operation and at the final follow up was recorded and compared between the two groups.Maryland score and the36item short form(SF36)were used to evaluate the therapeutic effect after operation.ResultsThere was no significant difference in age,falling height and interval time from injury to operation between the two groups.The average follow up time was(134±20)months in the observation group,and(143±24)months in the control group.One case of incision swelling and1case of skin necrosis were found in the control group,and no wound complication was observed in the observation group.All patients in the two groups were obtained bone union at the final follow up.Bhler angle and Gissane angle in the two groups were significantly better after operation in comparison to before operation(P<005).No significant difference was found in the median Maryland score and SF36score between the two groups(P>005).ConclusionThere is similar therapeutic effect in the management of Sanders typeⅡcalcaneal fractures between the ORIF via sinus tarsi approach combined with lateral longitudinal approach and ORIF via a lateral L type incision,but the former way has advantages such as less incision complication and lower stiffness subtalar joint rate.