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

Effects of sacral sinus limited incision and internal fixation on foot and ankle function and complications in patients with SandersⅡandⅢintra-articular fractures

目的观察跗骨窦有限切口内固定术对SandersⅡ、Ⅲ型跟骨关节内骨折患者的足踝功能和并发症的影响。方法采用前瞻性试验方法,选取2014年1月至2018年10月武警北京市总队医院外二科收治的125例SandersⅡ、Ⅲ型跟骨关节内骨折患者,采用随机双盲对照法将其随机分为两组:对照组(n=62)和研究组(n=63)。对照组患者行外侧“L”形切口内固定术,研究组患者行跗骨窦有限切口内固定术。比较两组患者的手术相关指标[手术时间、切口长度、术中出血量、术后视觉模拟评分(VAS)、骨折愈合时间]以及治疗前后的足踝功能(Bohler角、Gissane角、Langre角、跟骨宽度)以及并发症发生情况。结果研究组患者的手术时间(55.95±8.42 min vs.92.48±9.37 min)、切口长度(3.49±1.24 cm vs.8.34±2.15 cm)、术中出血量(62.48±5.37 ml vs.87.95±7.59 ml)、术后VAS评分(4.29±1.30分vs.6.28±1.48分)均优于对照组,差异具有统计学意义(P<0.05);骨折愈合时间(110.95±20.83 d vs.112.98±24.51 d)组间比较差异无统计学意义(P>0.05);治疗后,两组患者的Bohler角(29.58±2.59°vs.30.25±3.59°)、Gissane角(128.57±17.93°vs.125.87±16.59°)、Langre角(93.58±9.65°vs.92.58±8.26°)、跟骨宽度(28.01±4.24°vs.27.49±3.59°)比较差异无统计学意义(P>0.05);研究组患者的并发症发生率低于对照组(9.52%vs.32.26%),差异具有统计学意义(P<0.05)。结论跗骨窦有限切口内固定术能够获得与常规外侧“L”形切口内固定术基本相同的治疗效果,但前者的手术时间更短、组织创伤更低、并发症更少,兼具较好的有效性和安全性,更利于患者术后快速康复。

Objective To observe the tarsal sinus limited incision fixation of SandersⅡ,Ⅲankle function and complications in patients with intra-articular calcaneal fractures.Methods A prospective trial method was used to select 125 patients with Sanders II and III intra-articular fractures admitted to the Second Department of Beijing Armed Police Hospital from January 2014 to October 2018.The patients were divided into two groups,including control group(n=62)and study group(n=63).Patients in the control group underwent lateral"L"incision and internal fixation,and patients in the study group underwent limited iliac sinus internal fixation.Surgical related indicators[operation time,incision length,intraoperative blood loss,postoperative visual analogue scale(VAS),fracture healing time],foot and ankle function(Bohler angle,Gissane angle before and after treatment)and complications were compared between the two groups.Results In the study group,the operation time(55.95±8.42 min vs.92.48±9.37 min),the length of the incision(3.49±1.24 cm vs.8.34±2.15 cm),the intraoperative blood loss(62.48±5.37 ml vs.87.95±7.59 ml),and the postoperative VAS score(4.29±1.30 points vs.6.28±1.48 points)were better than the control group,the difference was statistically significant(P<0.05);fracture healing time(110.95±20.83 d vs.112.98±24.51 d)was not statistically significant between groups(P>0.05).After treatment,the Bohler angle(29.58±2.59°vs.30.25±3.59°),Gissane angle(128.57±17.93°vs.125.87±16.59°),Langre angle(93.58±9.65°vs.92.58±8.26°),followed by the two groups of patients,followed by Bone width(28.01±4.24?vs.27.49±3.59?)was not significantly different(P>0.05).The incidence of complications in the study group was lower than that in the control group(9.52%vs.32.26%),and the difference was statistically significant(P<0.05).Conclusion The limited incision internal fixation of tarsal sinus can achieve basically the same therapeutic effect as the conventional external L-shaped incision internal fixation,but the operation time of the former is shorter,the tissue trauma is lower,and the complications are less,which is both effective and safe,and more conducive to the rapid postoperative recovery of patients.