距下关节镜联合后侧小切口在跟骨骨折手术中的应用

Arthroscopic surgery plus one or more posterior small incisions for calcaneal fractures

目的通过比较距下关节镜联合后侧小切口与跗骨窦切口治疗跟骨骨折的疗效,观察距下关节镜联合后侧小切口治疗跟骨骨折的可行性。方法回顾性分析广州市正骨医院足踝外科2017年1月至2017年6月收治的85例跟骨骨折患者资料。患者男43例,女42例;年龄32~58岁,平均46.0岁。根据治疗方法不同分为距下关节镜联合后侧小切口手术治疗(关节镜组,40例)和经跗骨窦切口治疗(跗骨窦组,45例)。记录并比较两组患者的手术时间、骨折愈合时间、切口并发症发生率,以及美国足踝外科协会(AOFAS)的踝-后足评分。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获6~12个月(平均8个月)随访。关节镜组和跗骨窦组的骨折愈合时间分别为(8.6±2.4)周和(8.9±1.8)周,末次随访时的AOFOS的踝-后足评分分别为(82.5±5.6)分和(85.1±4.0)分,差异无统计学意义(P>0.05);关节镜组手术时间[(43.6±5.4)min]少于跗骨窦组[(56.5±6.4)min],关节镜组的切口并发症发生率2.5%(1/40)低于跗骨窦组15.6%(7/45),差异均有统计学意义(P<0.05)。结论距下关节镜联合后侧小切口治疗跟骨骨折可以一定程度上降低切口并发症的发生率,可以作为治疗跟骨骨折的一种可行的手术方法。

Objective To compare the effects of arthroscopic surgery plus one or more posterior small incisions and the sinus tarsi approach in the treatment of calcaneal fracture.Methods A retrospective analysis was conducted of the 85 patients with calcaneal fracture who had been treated from January 2017 to June 2017 at Department of Foot&Ankle Surgery,Guangzhou Orthopaedic Hospital.They were 43 men and 42 women,32 to 58 years of age(average,46.0 years).Arthroscopic surgery plus one or more posterior small incisions was performed in 40 of them while the sinus tarsi approach was used in the other 45 cases.The 2 groups were compared in terms of operation time,fracture healing time,incision complications and functions of the affected foot by the American Orthopedic Foot Ankle Society(AOFAS)ankle-hindfoot scores.Results There were no significant differences in the preoperative general data between the 2 groups,showing they were comparable(P>0.05).The average follow-up period for all the patients was 8 months(from 6 to 12 months).For the arthroscopic surgery group and sinus tarsi approach group,the fracture healing time was 8.6±2.4 weeks and 8.9±1.8 weeks,and the AOFAS ankle-hindfoot scores were 82.5±5.6 and 85.1±4.0,respectively,showing no significant differences between them(P>0.05).The operation time in the arthroscopic surgery group(43.6±5.4 min)was significantly less than in the sinus tarsi approach group(56.5±6.4 minutes),and the rate of complications in the former[2.5%(1/40)]significantly lower than in the latter[15.6%(7/45)](P<0.05).Conclusion Arthroscopic surgery plus one or more posterior small incisions may be a fine treatment for calcaneal fractures because postoperative incision complications can be reduced.