跗骨窦有限切口内固定术对SandersⅡ、Ⅲ型跟骨关节内骨折患者足踝功能及并发症的影响分析

Analysis on the effects of limited internal fixation of tarsal sinus incision on ankle function and complications in patients with Sanders types Ⅱ and Ⅲ intra-articular calcaneal fractures

目的以SandersⅡ、Ⅲ型跟骨关节内骨折患者为研究对象,分析患者应用跗骨窦有限切口内固定术的效果。方法随机纳入62例2017年10月~2019年1月在我院接受治疗的SandersⅡ、Ⅲ型跟骨关节内骨折患者,采用随机数字表法将其分为两组,参考组(n=31)患者采用跟骨外侧L型切口内固定术,研究组(n=31)患者采用跗骨窦有限切口内固定术,对比患者手术时间等手术情况以及术后骨折愈合时间,测量手术前后患者Langre角、Gissane角以及Bohler角并进行组间对比,比较手术前后患者Maryland评分及Morrey法,统计并对比患者术后并发症情况。结果研究组手术时间及骨折愈合时间均较参考组短,差异有统计学意义(P <0.05),术中出血量明显更少且切口长度明显更短,差异有统计学意义(P <0.05)。术后患者Morrey评分均低于术前,MaryLand评分均高于术前,差异有统计学意义(P <0.05),术后患者Morrey评分及MaryLand评分比较,差异无统计学意义(P> 0.05)。研究组感染、血肿等并发症总发生率9.68%,参考组总发生率25.81%,研究组感染等并发症总发生率较参考组,差异有统计学意义(P <0.05)。结论跟骨外侧L型切口内固定术及跗骨窦有限切口内固定术在SandersⅡ、Ⅲ型跟骨关节内骨折治疗中均能够取得较好的足踝功能改善效果,但是跗骨窦有限切口内固定术手术创伤更小且能够缩短其手术时间及骨折愈合时间,同时还能够降低术后并发症发生风险。

Objective The patients with Sanders types Ⅱ and Ⅲ intra-articular calcaneal fractures were taken as the study objects to analyze the effects of the application of limited internal fixation of tarsal sinus incision. Methods 62 patients with Sanders types Ⅱ and Ⅲ intra-articular calcaneal fractures who were treated at our hospital from October 2017 to January 2019 were randomly included as the study objects,and divided into two groups by random number table method.Patients in the reference group(n=31) were treated with internal fixation of L-shaped incision in lateral calcaneus,while patients in the study group(n=31) were treated with limited internal fixation of tarsal sinus incision.The operation conditions such as operation time,etc.and postoperative fracture healing time were compared among the patients.Langre,Gissane and Bohler angles of patients were measured before and after surgery,and intergroup comparisons were made.The Maryland score and Morrey method of patients were compared before and after surgery,and the postoperative complications of patients were counted and compared. Results The operation time and fracture healing time in the study group were shorter than those in the reference group,with statistically significant difference(P < 0.05);The intraoperative bleeding volume was significantly lower and the incision length was significantly shorter,with statistically significant difference(P < 0.05).The Morrey score of patients before surgery was lower than that before surgery, and the MaryLand score was higher than that before surgery,with statistically significant difference(P < 0.05);There was no statistically significant difference in the Morrey score and MaryLand score of patients after surgery between the groups(P > 0.05).The overall incidence of complications such as infection and hematoma in the study group was 9.68%,while that in the reference group was 25.81%.There was statistically significant difference in the overall incidence of complications such as infection between the study group and the reference group(P < 0.05). Conclusion Internal fixation of L-shaped incision in lateral calcaneus and limited internal fixation of tarsal sinus incision in the treatment of Sanders types Ⅱ and Ⅲ intra-articular calcaneal fractures can achieve better effect of improving ankle function,but the limited internal fixation of tarsal sinus incision has less surgical trauma,can shorten the operation time and fracture healing time,and can also reduce the risk of postoperative complications.