经跗骨窦切口内固定术在Sander Ⅱ～Ⅲ型跟骨骨折的应用

Application of tarsal sinus incision internal fixation in Sander Ⅱ～Ⅲ calcaneal fracture

目的:探讨Sander Ⅱ~Ⅲ型跟骨骨折患者行经跗骨窦小切口内固定术的应用效果。方法:纳入聊城市复退军人医院骨科2017年1至12月收治的84例Sander Ⅱ~Ⅲ型跟骨骨折患者,随机分为对照组与研究组,每组各42例。对照组采用经典经外侧“L”型切口治疗,研究组采用经跗骨窦切口内固定术治疗。影像学评价手术前后骨解剖测量数据变化。术后门诊随访6个月,采用美国足踝外科协会踝与后足功能(American Orthopaedic Foot&Ankle Society,AOFAS)评分和视觉模拟疼痛(Visual Analogue Scale,VAS)评分评估手术效果,并统计并发症情况。结果:研究组术中出血量、引流量低于对照组(P<0.05),两组术后Bohler角、Cissane角和跟骨中部宽度改善情况,差异无统计学意义(P>0.05);随访6个月,两组AOFAS评分优良率、VAS评分比较,差异无统计学意义(P>0.05),研究组并发症率低于对照组(P<0.05)。结论:经跗骨窦切口内固定术治疗Sander Ⅱ~Ⅲ型跟骨骨折不仅可取得同经典经外侧“L”型切口术相接近的手术效果,而且在手术出血量、引流量及并发症方面具有明显优势,临床应用价值显著。

Objective:To investigate the effect of transtarsal sinus small incision internal fixation for Sander Ⅱ~Ⅲ calcaneal fracture.Methods:A total of 84 patients with Sander Ⅱ~Ⅲ calcaneal fractures admitted to Department of Orthopaedics from January 2017 to December 2017 were randomly divided into a control group and a study group,42 cases in each group.The control group was treated with classical lateral “L” incision,while the study group was treated with transtarsal sinus incision internal fixation.Radiographic evaluation of bone anatomical measurement data before and after operation.The outpatient follow-up was 6 months.AOFAS score and VAS score were used to evaluate the effect of the operation,and the complications were counted.Results:The intraoperative bleeding volume and drainage volume in the study group were lower than those in the control group (P<0.05).There was no significant difference in the improvement of Bohler angle,Cissane angle and the width of the middle calcaneus between the two groups (P>0.05).At the end of 6-month follow-up,there was no significant difference in American Orthopaedic Foot & Ankle Society (AOFAS) score and Visual Analogue Scale (VAS) score between the two groups (P>0.05),and the complication rate in the study group was lower than that in the control group (P<0.05).Conclusion:Transtarsal sinus incision internal fixation for Sander Ⅱ~Ⅲ calcaneal fracture can not only achieve the same surgical effect as classical lateral “L” incision,but also have obvious advantages in operative bleeding volume,drainage volume and complications.It has significant clinical application value.