全关节镜辅助下空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折

Total arthroscopy-assisted reduction and internal fixation with cannulated screws for Sanders Ⅱ and Ⅲ calcaneal fractures

背景:近年来关节镜技术被广泛应用于跟骨骨折治疗中,但多用于治疗SandersⅠ、Ⅱ型骨折,或作为复杂的跟骨骨折的辅助复位、关节内损伤探查清理的辅助手段。目的:探讨全关节镜辅助下复位空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的效果。方法:选择2016年12月至2018年11月佛山市中医院收治的42例(42足)SandersⅡ、Ⅲ型跟骨骨折患者,按照手术方案分2组,全关节镜入路组(n=21)接受全关节镜辅助下复位空心螺钉内固定治疗,跗骨窦入路组(n=21)接受跗骨窦入路跟骨解剖板内固定治疗。术后随访12个月,记录不良反应发生情况;复查X射线片,检测B?hler角及Gissane角;评估Maryland足功能评分及AOFAS踝-后足评分量表评分。试验已通过佛山市中医院伦理委员会批准。结果与结论:①跗骨窦入路组术前准备时间、平均住院时间长于全关节镜入路组(P<0.05);全关节镜入路组无胫后血管、胫神经及腓肠神经损伤,无切口软组织感染;跗骨窦入路组发生皮肤浅表感染3足、腓肠神经损伤1足,无切口软组织深部感染及坏死;②术后12个月时,两组B?hler角及Gissane角均较术前明显改善(P<0.05),两组间比较差异均无显著性意义(P>0.05);③两组术后的踝关节周径均较术前明显减少(P<0.05),踝关节屈伸活动度均较术前明显增加(P<0.05);全关节镜入路组术后1个月的踝关节周径小于跗骨窦入路组(P<0.05),两组间术后1年的踝关节屈伸活动度比较差异无显著性意义(P>0.05);④术后12个月时,两组Maryland足功能评分及AOFAS踝-后足评分比较差异均无显著性意义(P>0.05);⑤结果表明与跗骨窦入路跟骨解剖板内固定相比,全关节镜辅助下复位空心螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折有利于促进患者足部功能恢复,减少术后并发症的发生。

BACKGROUND: In recent years, arthroscopy has been widely used in the treatment of calcaneal fractures, but it is often used to treat Sanders type I and II fractures, or as an auxiliary means of complex calcaneal fracture reduction and intraarticular injury exploration and cleaning. OBJECTIVE: To explore the effect of total arthroscopy-assisted reduction and internal fixation with cannulated screws for treatment of Sanders II and III calcaneal fractures. METHODS: From December 2016 to November 2018, 42 patients(42 feet) of Sanders II and III calcaneal fractures treated in Foshan Hospital of Traditional Chinese Medicine as the research subjects were divided into two groups according to the surgical plan. Patients in the total arthroscopy group(n=21) received total arthroscopy-assisted reduction and internal fixation with cannulated screws. Patients in the tarsal sinus approach group(n=21) received internal fixation of calcaneus anatomical plate through tarsal sinus approach. At 12 months after surgery, adverse reactions were recorded. X-ray films were reexamined. B?hler angle and Gissane angle were examined, and Maryland score and AOFAS ankle/hindfoot score were evaluated. This study was approved by the Ethics Committee of Foshan Hospital of Traditional Chinese Medicine. RESULTS AND CONCLUSION:(1) Preoperative preparation time and average hospital stay were longer in the tarsal sinus approach group than in the total arthroscopy group(P<0.05). There was no injury of posterior tibial vessels, tibial nerve or sural nerve, and no infection of soft tissue in the incision in the total arthroscopy group. In the tarsal sinus approach group, there were three feet with superficial skin infection, one foot with gastrocnemial nerve injury, and no deep incision infection or necrosis.(2) At 12 months after operation, B?hler and Gissane angles in both groups were better than before surgery(P<0.05), but there was no significant difference between the two groups(P>0.05).(3) Perimeter of the ankle was significantly reduced after surgery than before surgery in both groups(P<0.05), and motion range of ankle flexion and extension was significantly increased after surgery than before surgery in both groups(P<0.05). The perimeter of the ankle was smaller in the total arthroscopy group than in the tarsal sinus approach group at 1 month after surgery(P<0.05). Motion range of ankle flexion and extension was not significantly different at postoperative 1 year in both groups(P>0.05).(4) At postoperative 12 months, Maryland scores and AOFAS ankle/hindfoot scores were not significantly different between the two groups(P>0.05).(5) Compared with internal fixation of calcaneus anatomical plate through tarsal sinus approach, total arthroscopy-assisted reduction and internal fixation with cannulated screws for the treatment of Sanders II and III calcaneal fractures can promote the recovery of the patient’s foot function and reduce postoperative complications.