经跗骨窦入路治疗合并切口并发症高危因素的跟骨骨折疗效观察

Effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications

目的探讨经跗骨窦入路治疗合并切口并发症高危因素的跟骨骨折的疗效。方法回顾分析2015年7月至2017年7月锦州市中心医院收治的18例合并切口并发症高危因素的跟骨骨折患者的临床资料。其中,合并糖尿病8例,长期吸烟13例,吸烟合并糖尿病3例。入院后禁止患者主动及被动吸烟,监测和控制空腹及餐后血糖,同时行石膏固定,抬高患肢、冷敷消肿治疗。待血糖平稳,局部肿胀减轻后经跗骨窦入路行骨折复位固定,术后石膏托固定1~2周后开始免负重功能练习,术后早活动晚负重,最早于术后12周开始负重行走。结果患者随访12~20个月,平均14.3个月。无皮肤坏死、感染发生,所有骨折均愈合,骨折愈合时间11~16周,平均13.5周。采用美国骨科足踝外科协会踝-后足功能评分评定疗效,优6例,良10例,可2例。结论经跗骨窦入路治疗跟骨骨折对软组织干扰小,尤其适合于合并切口并发症高危因素的患者,能有效避免切口并发症的发生,同时术后功能恢复满意,是治疗跟骨骨折的良好手术入路。

Objective To study the effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications. Methods The clinical data of 18 patients with calcaneus fracture combined with high risk factors of incision complications in Jinzhou Center Hospital from July 2015 to July 2017 were retrospectively analyzed. In all patients, combined diabetes mellitus was in 8 cases, long-term smoking history was in 13 cases, combined diabetes mellitus and smoking was in 3 cases. Active and passive smoking were prohibited in hospital, and fasting and postprandial blood glucose were monitored and controlled. In order to reduce swelling, plaster fixation, limb elevation and cold compression were performed. After the blood glucose was stable and local swelling was reduced, surgery was performed via the sinus tarsi approach. After 1 to 2 weeks of postoperative gypsum fixation, the non-weight-bearing function exercise was allowed. After early activities and late loading, the weight-bearing function exercise began at least 12 weeks after surgery. Results All patients were followed up for 12 to 20 months (mean 14.3 months). No skin necrosis and infection occurred. All fractures healed, and fracture healing time was 11 to 16 weeks, with mean time of 13.5 weeks. The American Orthopaedic Foot and Ankle Society Ankle Hindfoot score was used to evaluate the curative effect. Six cases were excellent, 10 cases were good, and 2 cases were passable. Conclusions Treatment of calcaneal fracture via tarsal sinus approach has little interference with soft tissue. It is especially suitable for the patients with high risk factors of incision complications, which can effectively avoid the occurrence of incision complications. At the same time, the postoperative functional recovery is satisfactory. It is a good approach in patients with calcaneal fracture combined with high risk factors of incision complications.