跗骨窦切口与外侧L形切口内固定治疗SandersⅡ型跟骨骨折的疗效

The efficacy of the tarsal sinus approach and the lateral L-type approach in the treatment of patients with Sanders type Ⅱ calcaneal fractures

目的比较跗骨窦切口空心钉微型钢板内固定和外侧L形切口钢板内固定治疗SandersⅡ型跟骨骨折的临床疗效。方法将45例SandersⅡ型跟骨骨折患者按治疗方法不同分为A组(25例,采用L形切口内固定)与B组(20例,采用跗骨窦切口内固定),比较两组手术情况、影像学指标、术后AOFAS踝-后足功能评分及并发症。结果患者均获得随访,时间8～13个月。手术时间、术中出血量B组明显少于A组(P <0. 05)。术后跟骨长度、宽度、高度和B9hler角、Gissane角两组均较术前明显改善(P <0. 05),两组间比较差异无统计学意义(P> 0. 05)。术后6个月AOFAS评分及术后并发症情况B组均优于A组,但差异均无统计学意义(P> 0. 05)。结论跗骨窦切口与L形切口内固定均是治疗跟骨骨折的有效方式,与L形切口内固定比较,跗骨窦切口内固定具有微创复位固定距下关节面、手术时间短及切口并发症少等优势。

Objective To compare the clinical efficacy of cannulated screw internal plate fixation via the tarsal sinus approach and the plate fixation via the lateral L-shaped approach in treatment of patients with Sanders typeⅡcalcaneal fractures.Methods A total of 45 cases Sanders typeⅡcalcaneal fractures were divided into group A(25 cases were treated with L-type approach)and group B(20 cases were treated with tarsal sinus approach).Those two groups were compared for basic condition of the operation,imaging indexes,postoperative AOFAS ankle-hindfoot fuction score and complications.Results All the patients were followed up for 8~13 months.The operation time and blood loss of group B were significantly less than those in group A(P<0.05).The calcaneal length,width,height,B hler angle and Gissane angle of both two groups were significantly improved postoperatively,compared with those preoperatively(P<0.05).However,those postoperative imaging indexes showed no difference between group A and group B(P>0.05).Group B was preformed better in AOFAS ankle-hindfoot fuction score at 6 months postoperation and postoperative complications than group A,but without a statistical difference(P>0.05).Conclusions Both tarsal sinus approach and lateral L-shaped approach are effective surgeries for calcaneal fractures.Compared with lateral L-shaped approach,tarsal sinus approach show an advantage in minimally invasive treatment of subtalar joint noodles,with shorter operative time and fewer postoperative complications.