跗骨窦入路切开复位内固定与外侧"L"形入路切开复位内固定治疗跟骨骨折的疗效比较研究

Comparative Study of the Curative Effect of Tarsal Sinus Approach with Open Reduction and Internal Fixation and Lateral "L"-shaped Approach with Open Reduction and Internal Fixation for the Treatment of Calcaneal Fractures

目的:比较跗骨窦入路切开复位内固定与外侧"L"形入路切开复位内固定治疗跟骨骨折的疗效。方法:选取2016年10月到2017年6月期间川北医学院附属医院收治的86例跟骨骨折患者,根据随机数字表法分为对照组和观察组,两组均为43例。对照组采用外侧"L"形入路切开复位内固定进行治疗,观察组采用跗骨窦入路切开复位内固定进行治疗。比较两组患者的手术时间、住院时间、骨折愈合时间、踝-后足功能优良率、视觉模拟评分法(VAS)、B?hler角、Gissane角和术后并发症发生率。结果:两组患者的手术时间和骨折愈合时间比较无统计学差异(P>0.05),而观察组患者的住院时间短于对照组(P<0.05)。观察组患者术后踝-后足功能优良率高于对照组(P<0.05)。在术前和术后12个月时,两组患者的VAS评分、Gissane角、B?hler角比较无统计学差异(P>0.05),术后12个月时两组患者的VAS评分均明显低于术前,B?hler角及Gissane角明显高于术前(P<0.05)。观察组患者术后并发症发生率低于对照组(P<0.05)。结论:跗骨窦入路和外侧"L"形入路切开复位内固定均可有效治疗跟骨骨折,但跗骨窦入路可更有效地改善踝-后足功能,且住院时间短、术后并发症发生率更低。

Objective: To compare the curative effect of tarsal sinus approach with open reduction and internal fixation and lateral "L"-shaped approach with open reduction and internal fixation for the treatment of calcaneal fractures. Methods: 86 patients with calcaneal fractures who were treated at the Affiliated Hospital of North Sichuan Medical College from October 2016 to June 2017 were enrolled. The patients were divided into the control group and the observation group according to the random number table method, and 43 patients in both groups. The control group was treated with lateral "L"-shaped approach with open reduction and internal fixation. The observation group was treated with tarsal sinus approach with open reduction and internal fixation. The operation time, hospitalization time, fracture healing time, sputum-hind foot function, VAS score, B?hler angle, Gissane angle and postoperative complication rate were compared between the two groups. Results: There was no difference in the operation time and fracture healing time between the two groups(P>0.05). The hospitalization time of the observation group was shorter than that of the control group(P<0.05). The talus-hind foot function excellent rate in the observation group was higher than that in the control group(P <0.05). There were no significant differences in VAS score, B?hler angle and Gissane angle between the two groups before and 12 months after operation(P>0.05). At 12 months after operation, the VAS scores of both groups were significantly lower than those before operation, and the B?hler angle and Gissane angle were significantly higher than those before operation(P<0.05). The incidence rate of postoperative complications in the observation group was lower than that in the control group(P<0.05). Conclusion: The sacral sinus approach and the lateral "L" approach with open reduction and internal fixation can effectively treat calcaneal fractures. However, tarsal sinus approach can improve ankle-hind foot function more effectively, with shorter hospitalization time and lower incidence of postoperative complications.