两种入路治疗SandersⅡ、Ⅲ型跟骨骨折的疗效观察

Clinical observation of two approaches for treatment of Sanders Ⅱ and Ⅲ calcaneal fractures

目的探讨跗骨窦入路与外侧"L"型扩大入路治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法回顾性分析2012年3月-2017年2月南京梅山医院骨科收治的72例SandersⅡ、Ⅲ型跟骨骨折患者资料,按手术入路分为跗骨窦入路组和外侧扩大"L"形入路组。跗骨窦入路组34例,其中男性21例,女性13例,左足18例,右足16例;年龄26~74岁,平均43.4岁。外侧扩大"L"型入路组38例,其中男性30例,女性8例,左足17例,右足21例;年龄27~72岁,平均43.1岁。比较两组患者受伤到手术的时间、切口长度、手术时间、术后引流量、术后疼痛视觉模拟(VAS)评分、AOFAS评分及骨折愈合时间。结果 72例患者经全程门诊随访12~18个月,平均14.3个月。外侧扩大"L"型入路组2例患者切口有较多渗液,经换药后好转;跗骨窦入路组1例出现腓肠神经牵拉症状。外侧扩大"L"型入路组和跗骨窦入路组受伤到手术的时间[(10.21±1.29)d vs.(5.30±0.68)d,P<0.05]、切口长度[(13.03±0.82)cm vs.(6.84±0.39)cm,P<0.05]、手术时间[(96.80±11.30)min vs.(80.60±5.90)min,P<0.05]、术后引流量[(108.20±13.30)mL vs.(98.20±12.60)mL,P<0.05]、术后VAS评分[(5.40±0.90)分vs.(4.10±1.00)分,P<0.05],差异均有统计学意义(P<0.05);而在AOFAS评分方面差异无统计学意义(P>0.05)。结论跗骨窦入路在术前等待时间、切口长度、手术时间、术后引流量、VAS评分方面相对于外侧扩大"L"型入路有优势,对于SandersⅡ、Ⅲ型跟骨骨折,跗骨窦入路可替代外侧扩大"L"型入路。

Objective To evaluate the efficacy of the sinus approach and the lateral "L" approach for the treatment of Sanders II and III calcaneal fractures.Methods Totally 72 cases of Sandaers Type Ⅱ and Type Ⅲ calcaneal fracture were treated in Orthopedics Department of Nanjing Meishan Hosptial from Mar.2012 to Feb.2017.These patients were divided into tarsal sinus approach group(TS group) and expanded lateral "L" shape approach group(EL group).There were 34 cases in TS group,including 21 males and 13 females,with 18 on the left foot and 16 on the right aged from 26 years to 74 years,with the mean age of 43.4 years.In EL group,there were 38 cases including 30 males and 8 females,with 17 on the left foot and 21 on the right aged from 27 years to 72 years,and the mean age was 43.1 years.Comparison of the time from injury to surgery,incision length,operation time,postoperative drainage volume,visual analogue score(VAS) of postoperative pain,AOFAS score and bone healing time of the two groups was carried out.Results All the 72 patients were given follow-up of 12 to 18 months,and the average time was 14.3 months.There were 2 patients with more incision solution in EL group,and getting better after changing dressing.And there was 1 patient with stretch symptoms of sural nerve in TS group.The time from injury to surgery was(10.21±1.29) days in EL group and(5.3±0.68) days in TS group(P<0.05).The incision length was(13.03±0.82) cm in EL group and(6.84±0.39) cm in TS group(P<0.05).The operation time was(96.8±11.30) min in EL group and(80.6±5.90) min in TS group(P<0.05).The drainage volume was(108.2±13.30) mL in EL group and(98.2±12.60) mL in TS group(P<0.05).The VAS was 5.4±0.90 in EL group and 4.1±1.00 in TS group(P<0.05).There was statistical differenceal between the two groups.TS group was better than EL group.But there was no statistical difference in AOFAS score(P>0.05).Conclusion Surgical treatment of calcaneal fractures using tarsal sinus approach leads to less time from injury to surgery,smaller incision,less operation time,lower drainage volume and VAS,while the same effect and easy procedure compared with traditional approach.It can be used as an alternative to the expanded lateral "L" shape approach for the treatment of Sanders Type Ⅱ and Type Ⅲ calcaneal fractures.