经跗骨窦入路结合新型跟骨微创解剖锁定接骨板治疗跟骨骨折的学习曲线

The learning curve of the treatment of calcaneal fracture through tarsal sinus approach combined with a new type of minimally invasive anatomical locking plate of calcaneus

目的探讨经跗骨窦入路结合新型跟骨微创解剖锁定接骨板治疗跟骨骨折的学习曲线。方法回顾性分析本院2017年8月—2018年8月收治的113例SandersⅡ、Ⅲ型跟骨骨折患者,共120足。所有患者按手术治疗时间先后顺序分为A,B,C,D组,每组各30足。均采用经跗骨窦入路结合新型跟骨微创解剖锁定接骨板治疗跟骨骨折的方法。组内比较术前及术后跟骨Bohler角、Gissane角、跟骨长度、高度等解剖学参数,组间比较手术时间、视觉模拟评分(visual analogue score,VAS)及美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足评分。结果四组手术时间比较,差异有统计学意义(P<0.01)。进一步两两比较结果显示,与A组比较,B、C、D组手术时间缩短,差异有统计学意义;与B组比较,C、D组手术时间缩短,差异有统计学意义(P<0.01)。。四组间VAS评分和AOFAS评分比较,差异无统计学意义(P>0.05)。各组内术前及术后Bohler角、Gissane角、跟骨长度和跟骨高度的解剖数据比较,差异均有统计学意义(P<0.01)。结论经跗骨窦入路结合新型跟骨微创解剖锁定接骨板治疗跟骨骨折是一种有效且颇具优势的治疗SandersⅡ、Ⅲ型跟骨骨折的手术方法,手术效果良好。该术式的学习曲线为60例,并且在学习曲线早期,通过不断总结经验技巧,能够有效缩短手术时间,减少手术并发症,加速术后早期康复。

Objective To evaluate the learning curve of the treatment of calcaneal fracture through tarsal sinus approach combined with a new type of minimally invasive anatomical locking plate of calcaneus.Methods A retrospective analysis of 113 Sanders typeⅡandⅢcalcaneal fractures(120 feet)admitted from August 2017 to August 2018 in our hospital.These cases were divided into A,B,C,D groups according to the time sequence,and each group had 30 cases.All of them were treated with the tarsal sinus approach combined with the new calcaneus minimally invasive anatomical locking plate.The anatomic parameters such as Bohler angle,Gissane angle,calcaneus length and calcaneus height were compared before and after operation in each group.The operation time,VAS score and AOFAS score were compared between groups.Results There was significant difference in operation time between the four groups(P<0.01).Compared with group A,the operation time of group B,C and D was shortened,the difference was statistically significant(P<0.01).And compared with group B,the operation time of group C and D was shorter,the difference was statistically significant(P<0.01).There was no significant difference between the four groups in VAS score and AOFAS score(P>0.05).There were statistically significant differences in the anatomical data of Bohler angle,gissane angle,calcaneus length and calcaneus height before and after operation in each group(P<0.01).Conclusion The treatment of calcaneal fracture with new type calcaneus minimally invasive anatomical locking plate via tarsal sinus is an effective and advantageous operation method for sandersⅡandⅢfractures of calcaneus.The operation effect of this method is good.and the learning curve of yhis snrgical treatment is about 60 cases.what's more,in the early learning curve,by continuously summing up experience and skills,it can effectively shorten the operation time,reduce the complications of hand operation,and accelerate the early rehabilitation after operation.