跗骨窦入路结合微型锁定板治疗SandersⅡ、Ⅲ型跟骨骨折

Treatment of Calcaneal Sanders Type Ⅱ and Ⅲ Fractures Withtarsal Sinus Approach Combined with Mini-locking Plate

目的探讨应用跗骨窦入路结合微型锁定板治疗SandersⅡ、Ⅲ型跟骨骨折的临床效果。方法2013年3月至2016年10月采用跗骨窦入路结合微型锁定板内固定治疗43例SandersⅡ、Ⅲ型跟骨骨折,男34例,女9例;年龄21~65岁,平均为43.7岁。Sanders分型:Ⅱ型26例,Ⅲ型17例。观察伤口愈合情况,Bohler角及Gissane角矫正情况,末次随访采用Marryland足功能评分。结果术后随访时间10~21个月,平均13.6个月。所有患者伤口一期愈合,无皮肤坏死、伤口感染等并发症,无骨折移位及内固定失败情况发生;1例患者术后出现了腓肠神经损伤症状,表现为足背外侧麻木,考虑与术中牵拉有关,未作处理,后自行恢复。术后复查X片,Bolher角和Gissane’s角平均恢复到34°和131°。采用Maryland足功能评分标准,优30例,良8,可5例。结论跗骨窦入路治疗SandersⅡ、Ⅲ型跟骨骨折有明显的优势,解决了传统外侧入路带来的伤口并发症及相关问题,值得临床推广。

Objective To explore the clinical effect of tarsal sinus approach combined with mini-locking plate in the treatment of calcaneal sandersⅡandⅢfractures.Methods From March 2013 to October 2016,43 cases of calcaneal sandersⅡandⅢfractures were treated with tarsal sinus approach combined with mini-locking plate internal fixation.There were 34 males and 9 females;aged 21-65 years,mean 43.7 years old.Sanders classification:26 cases of typeⅡ,17 cases of typeⅢ.The wound healing,Bohler’s angle and Gissane’s angle correction were observed.Marryland foot function score was used for the last follow-up.Results The follow-up time was 10-21 months,with an average of 13.6 months.All patients healed in the first stage without complications such as skin necrosis and wound infection.No fracture displacement and internal fixation failure occurred.One patient developed postoperative symptoms of sural nerve injury,which showed numbness of the lateral side of the foot.Considering the intraoperative traction,it was not treated and then recovered spontaneously.X-slices were reviewed postoperatively,and Bolher’s and Gissane’s angles were restored to 34°and 131°on average.According to Maryland foot function score,30 cases were excellent,8 cases were good and 5 cases were fair.Conclusion The tarsal sinus approach has obvious advantages in the treatment of calcaneal sandersⅡandⅢfractures,and solves the wound complications and related problems caused by the traditional lateral approach,which is worthy of clinical promotion.