跗骨窦入路和传统入路治疗跟骨骨折伤口并发症的比较

Comparison about sinus approach and traditional approach for the treatment of calcaneus fractures

目的比较跗骨窦切口入路和传统“L”形切口入路治疗跟骨骨折术后伤口并发症的差异。方法选取新疆军区总医院北京路医疗区2015年06月-2018年06月收治的跟骨骨折并行手术治疗的149例患者作为研究对象。将患者分成研究组和对照组,研究组患者接受跗骨窦入路切开复位内固定手术治疗,对照组患者接受传统L形切口入路切开复位内固定手术治疗。研究组68例患者,男64例,女4例,年龄38.09±10.46岁(18-74岁)。对照组81例患者,男72例,女9例,年龄38.81±11.85岁(18-65岁)。比较两组患者术后伤口并发症发生率、跟骨骨折矫正情况及术后足踝功能AOFAS评分。结果两组患者均顺利接受手术,经手术治疗,两组患者Bohler角和Gissane角较术前均得到明显改善(P<0.001),两组患者Bohler角和Gissane角矫正程度组间比较无差异(P>0.05),术后随访两组患者足踝功能AOFAS评分无差异(P>0.05)。对两组患者伤口并发症情况进行比较,研究组患者皮肤坏死、感染、渗出和伤口总并发症发生率均低于对照组(P<0.05)。结论跗骨窦切口入路较传统“L”形切口入路有着更低的伤口并发症发生率,且在骨折畸形矫正、术后足踝功能AOFAS评分上较传统“L”形切口入路无差异,值得临床推广。

Objective To compare the difference of postoperative wound complications between the sacral sinus incision and traditional L-shaped incision for the treatment of calcaneal fractures.Methods A total of 149 patients with calcaneus fractures hospitalized at the department of Orthopedics of Clinical Center at Beijing Road of general hospital of Xinjiang Military Region from June 2015 to June 2018 were selected as the research subjects.The patients were divided into study group and control group.The patients in the study group underwent open reduction and internal fixation with sacral sinus approach.The patients in the control group underwent open reduction and internal fixation with traditional L-shaped incision.There were 68 patients in the study group,64 males and 4 females,aged 38.09±10.46 years(about 18-74 years old).And there were 81 patients in the control group,72 males and 9 females,aged 38.81±11.85 years old(about 18-65 years old).The incidence of postoperative wound complications,the correction of calcaneal fractures and the postoperative ankle function AOFAS scores were compared between the two groups.Results Both groups of patients underwent surgery successfully.After operation,the Bohler angle and Gissane angle were significantly improved in both groups(P<0.001).There was no difference between the two groups(Bohler angle and Gissane angle correction degree)(P>0.05),and there was no difference in the ankle-function AOFAS score between the two groups(P>0.05).The wound complications of the two groups were compared.The incidences of skin necrosis,infection,exudation and total wound complications of the study group were lower than those of the control group(P<0.05).Conclusion The sacral sinus incision approach has a lower incidence of wound complication than the traditional L-shaped incision approach,and there is no difference in the fracture deformity correction and the postoperative ankle function AOFAS score compared with the traditional L-shaped incision approach.It is worthy of clinical promotion.