L形外侧扩大入路与跗骨窦间隙入路分别联合关节镜辅助下复位内固定在Sanders Ⅱ Ⅲ型跟骨骨折手术中的临床应用

Clinical Application of L-shaped Extended Lateral Approach and Sinus Tarsi Approach Respectively Combined with Arthroscope Assisted reduction and Internal Fixation in Sanders Ⅱ and Ⅲ Calcaneal Fracture Surgery

目的:探讨并对比L形外侧扩大入路与跗骨窦间隙入路分别联合关节镜辅助下复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的效果。方法:回顾性分析2014年8月至2016年8月医院76例接受关节镜辅助下复位内固定治疗的SandersⅡ、Ⅲ型跟骨骨折患者的病例资料,将L形外侧扩大入路患者作为切开组(31例),将跗骨窦间隙入路患者作为微创组(45例),统计两组手术情况及并发症发生率,比较两组放射学指标变化,术后6个月发放美国足踝外科协会(AOFAS)踝与后足功能评分评估患足功能恢复情况。结果:两组手术时间、骨折愈合时间、患足功能恢复优良率比较,差异无统计学意义(P>0.05),微创组术中出血量、术后引流量少于对照组,等待手术时间、切口长度、切口愈合时间短于切开组,差异有统计学意义(P<0.05)。两组末次随访时Bohler's角、跟骨高度、跟骨宽度增大,Gissane角、距下关节面移位距离减少,与术前比较差异有统计学意义(P<0.05),但两组末次随访时比较差异无统计学意义(P>0.05)。切开组切口相关并发症、距关节关节僵硬发生率显著高于微创组,差异有统计学意义(P<0.05)。结论:两种入路方式联合关节镜辅助下复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的固定效果相似,但与L形外侧扩大入路相比,跗骨窦间隙入路可减少手术创伤,进一步降低术后并发症发生率。

Objective:To investigate and compare the effects of L-shaped extended lateral approach and sinus tarsi approach respectively combined with arthroscope assisted reduction and internal fixation in the treatment of Sanders II and III calcaneal fractures.Methods:The data of 76 patients with Sanders II and III calcaneal fractures who underwent arthroscope assisted reduction and internal fixation in the hospital during the period from August 2014 to August 2016 were analyzed retrospectively.Patients treated by L-shaped extended lateral approach were included in the incision group(31 cases)while patients treated by sinus tarsi approach were included in the minimally invasive group(45 cases).The situation of surgery and the incidence of complications in the two groups were statistically analyzed.Changes in radiographic parameters were compared between the two groups.The recovery of foot function was evaluated with the ankle and hindfoot function scores in the American Orthopedic Foot Andankle Society(AOFAS)at 6 months after surgery.Results:There was no significant difference between the two groups in the surgical time,fracture healing time and the excellent and good rate of foot function recovery(P>0.05).The intraoperative blood loss and postoperative drainage volume of the minimally invasive group were less than those of the control group,the time of waiting for surgery,length of incision and incision healing time were shorter than those of the incision group(P<0.05).The Bohler's angle,calcaneal height and width were increased while the Gissane angle and shift distance of subtalar joint surface were decreased in the two groups at the end of follow-up(P<0.05),without statistically significant differences between the two groups(P>0.05).The incidence rates of incision related complications and fetlock joint stiffness in the incision group were significantly higher than those in the minimally invasive group(P<0.05).Conclusion:Effects of the two approaches combined with arthroscope assisted reduction and internal fixation are similar in the treatment of Sanders II and III calcaneal fractures.Compared with L-shaped extended lateral approach,sinus tarsi approach can reduce surgical trauma and further reduce the incidence of postoperative complications.