两种切口内固定治疗SandersⅡ、Ⅲ型跟骨骨折的比较

Ⅱ-shaped incision versus traditional L-shaped incision for open reduction and internal fixation of Sanders typeⅡ-Ⅲcalcaneal fractures

[目的]比较分析"八字"微创切口与传统"L"形切口复位钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。[方法]2016年1月~2018年1月,54例SandersⅡ、Ⅲ型跟骨骨折患者纳入本研究。采用随机数字表法将患者分为两组,27例采用"八字"微创切口内固定(微创组),27例采用传统跟骨"L"形切口复位钢板内固定(常规组)。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,微创组术前等待时间、手术时间、切口长度、术中失血量、住院时间均显著少常规组,差异有统计学意义(P<0.05)。微创组早期并发症发生率为3.70%(1/27),而传统组为29.63%(8/27),两组间早期并发症发生率的差异有统计学意义(P<0.05)。两组患者术后随访12月以上,微创组完全负重行走时间为(45.22±7.05)d,传统组为(58.74±6.25)d,两组间差异有统计学意义(P<0.05)。随术后时间延长,两组患者VAS评分显著减少,AOFAS评分和足内-外翻ROM显著增加(P<0.05)。在术后3个月和12个月时,微创组VAS评分均显著低于传统组(P<0.05),而微创组AOFAS评分均显著高传统组(P<0.05);但相应时间点,两组间足内-外翻ROM的差异均无统计学意义(P>0.05)。影像方面,两组患者术后12个月Bohler角和Gissane角均较术前显著增大,差异有统计学意义(P<0.05);相同时间点,两组间Bohler角和Gissane角的差异均无统计学意义(P>0.05)。[结论]"八字"微创切口复位钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折,手术及住院时间短、创伤小、切口并发症发生率显著降低,术后足部功能恢复满意。

[Objective]To compare the clinical outcomes ofⅡ-shaped incision versus traditional L-shaped incision for open reduction and internal fixation(ORIF)with plate and screws for treatment of Sanders typeⅡandⅢcalcaneal fractures.[Methods]From January 2016 to January 2018,a total of 54 patients with Sanders typeⅡandⅢcalcaneal fractures were enrolled into this study,and divided into two groups by the random number method in our hospital.Of them,27 patients received ORIF throughⅡ-shaped incision,a novel minimal invasive approach(the MI group),while the remaining 27 patients had ORIF through the traditional L-shaped incision(the traditional group).The perioperative,follow-up and radiographic documentations were compared between the two groups.[Results]All the patients in both groups had operation performed smoothly.The MI group proved significantly superior to the traditional groups regarding to waiting time before operation,operation time,incision length,intraoperative blood loss and hospital stay(P<0.05).The early complication rate was of 3.70%(1/27)in the MI group,whereas 29.63%(8/27)in the traditional group,which was statistically significant(P<0.05).All the patients in both groups were followed up for more than 12 months.The full weight bearing ambulation achieved at(45.22±7.05)d in the MI group,whereas(58.74±6.25)d in the traditional group,which was statistically significant(P<0.05).As time went postoperatively,the VAS scores significantly decreased(P<0.05),while the AOFAS scores and the foot inversion-eversion range of motion(ROM)significantly increased in both groups(P<0.05).At 3 and 12 months postoperatively,the MI group got significantly lower VAS scores,whereas significantly higher AOFAS scores than the traditional group(P<0.05),regardless of no statistical differences between the two groups in ROM(P>0.05).Regarding radiographic assessment,both Bohler angle and Gissane angle significant-ly increased at 12 months postoperatively compared those before operation in both groups(P<0.05),although there were no statistically significant differences in aforesaid pa-rameters between the two group at any corresponding time point(P>0.05).[Conclusion]ThisⅡ-shaped incision takes advantages of shortening operation time and hospital stay,minimizing iatrogenic lesser trauma,reducing postoperative complications,and improving restoration of the foot function over the traditional L-shaped incision for Sanders typeⅡandⅢcalcaneal fractures.