微创"八"字切口入路在Sanders Ⅱ、Ⅲ型跟骨骨折治疗中的应用

Minimally invasive splayed incisions for calcaneal fractures of sanders types Ⅱ and Ⅲ

目的评价采用微创"八"字切口入路常规跟骨解剖钢板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效。方法前瞻性研究2016年5月1日至2017年12月1日上海浦东医院骨科收治的40例跟骨骨折患者资料。患者年龄23~55岁,平均39.5岁;骨折根据Sanders分型:Ⅱ型27例,Ⅲ型13例。患者均采用微创"八"字切口入路常规跟骨解剖钢板治疗。比较患者术前、术后3个月、末次随访时的B?hler角、Gissane角、跟骨高度、宽度、长度,术后患肢临床功能采用Maryland足部评分评价,并观察并发症的发生情况。结果40例患者随访时间为11~16个月(平均12.5个月)。所有患者皮肤切口均愈合良好,无一例发生切口皮缘坏死及伤口感染,所有患者均无腓肠神经损伤。所有患者骨折愈合时间7~10周(平均8周);恢复日常活动并回到工作岗位的时间为3~6个月(平均4.1个月)。所有患者术前、术后3个月、末次随访时B?hler角分别为19.2°±6.3°、30.5°±6.4°、29.9°±6.5°,Gissane角分别为103.9°±14.8°、119.3°±5.6°、119.8°±6.3°,跟骨高度为(32.5±3.5)、(36.8±1.5)、(36.5±1.8) mm,宽度为(36.8±3.4)、(33.1±3.8)、(33.0±3.2)mm,长度为(61.4±4.5)、(65.5±6.9)、(65.5±9.4) mm;所有患者术后3个月、末次随访时B?hler角、Gissane角、跟骨高度、长度均较术前增加,跟骨宽度较术前减少,差异有统计学意义(P<0.05);而术后3个月B?hler角、Gissane角、跟骨高度、宽度、长度与末次随访时比较差异均无统计学意义(P>0.05)。Maryland足部评分:优35例,良4例,一般1例,优良率为97.5%。结论采用微创"八"字切口入路常规跟骨解剖钢板治疗Sanders Ⅱ、Ⅲ型跟骨骨折临床疗效好,可减少伤口并发症、恢复跟骨解剖形态和距下关节面平整。

Objective To evaluate the minimally invasive splayed incisions in the internal fixation with a conventional calcaneal plate for calcaneal fractures of sanders types Ⅱ and Ⅲ. Methods This prospective study was conducted from May 1st, 2016 to December 1st, 2017 in the 40 patients with calcaneal fracture at Department of Orthopedics, Shanghai Pudong Hospital. Their ages ranged from 23 to 55 years (average, 39.5 years). According to the Sanders classification, 27 fractures were type Ⅱ and 13 type Ⅲ. They were all treated with a conventional calcaneal plate through minimally invasive splayed incisions. The B?hler and Gissane angles, the height, width and length of the affected calcaneus were compared between preoperation, 3 months after operation and the last follow-up;the clinical function of the affected feet was graded using the Maryland foot score;postoperative complications were observed. Results The 40 patients were followed up for an average of 12.5 months (from 11 to 16 months). All the skin incisions healed well with no skin necrosis or wound infection. No injury to the sural nerve occurred. All the fractures healed after an average of 8 weeks (from 7 to 10 weeks). All the patients resumed their routine daily activities and returned to their former work post after an average time of 4.1 months (from 3 to 6 months). At pre-operation, 3 months after operation and the last follow-up, their B?hler angles were respectively 19.2°±6.3°, 30.5°±6.4° and 29.9°±6.5°;their Gissane angles 103.9°±14.8°, 119.3°±5.6° and 119.8°±6.3°;their calcaneal heights (32.5±3.5) mm,(36.8±1.5) mm and (36.5±1.8) mm;their calcaneal widths (36.8±3.4) mm,(33.1±3.8) mm and (33.0±3.2) mm;their lengths (61.4±4.5) mm,(65.5±6.9) mm and (65.5±9.4) mm. In all the patients, the B?hler and Gissane angles and the calcaneal heights and lengths increased significantly while the calcaneal widths decreased significantly at 3 months after operation and the last follow-up (P<0.05). There were no significant differences between 3 months after operation and the last follow-up in the B?hler or Gissane angle, the height, width or length of the affected calcaneus (P>0.05). Their Maryland foot scores showed 35 excellent cases, 4 good cases and one fair case, giving an excellent and good rate of 97.5%. Conclusions A conventional calcaneal plate plus minimally invasive splayed incisions can be effective for calcaneal fractures of Sanders types Ⅱ and Ⅲ, leading to reduced wound complications, anatomical restoration of calcaneal morphology, and smooth subtalar articular surface.