两种不同入路切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效对比

Comparison of Two Different Approaches to Open Reduction and Internal Fixation of Sanders Ⅱ and Ⅲ Calcaneal Fractures

目的:比较两种不同入路切开复位内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效。方法:自2013年6月~2016年6月诊治60例跟骨骨折患者,采用随机数字表法分为两组:对照组35例,研究组25例。对所有患者均进行临床和影像学评估。研究组采用跗骨窦入路微型钢板内固定治疗,对照组采用传统"L"形入路切开复位内固定术治疗。术后常规疼痛管理。对比两组的手术时间、术中失血量、术后并发症、切口长度和术前、术后疼痛VAS评分,以及术前、术后跟骨长、宽、高,B?hler角、Gissane角和跟骨内翻角;术后6个月采用AOFAS评分和Maryland评分评价足功能恢复情况。结果:两组患者的手术时间、术中失血量差异显著(P<0.05)。研究组的切口长度明显小于对照组,两组患者术后疼痛VAS评分均显著降低(P<0.05)。两组术后跟骨长、宽、高、B?hler角及Gissane角均优于术前,但两组间差异无统计学意义(P>0.05)。两组术后6个月的Maryland评分和AOFAS评分均高于术前,但两组之间无显著性差异(P>0.05)。两组术后并发症发生率存在显著性差异(P<0.05)。结论:采用跗骨窦入路微型钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折,可明显缩短手术时间,减少术中出血量和术后并发症的发生率,加快患者术后足部功能恢复,较外侧传统"L"形入路具有更好的疗效。

Objective To compare the clinical outcome of two different approaches to open reduction and internal fixation of Sanders Ⅱ and Ⅲ calcaneal fractures.Method Sixty patients with calcaneal fracture,treated between June 2013 and June 2016,were selected and randomly divided into an experimental group of 25 and a control group of 35. All patients were evaluated clinically and radiologically. Then the experimental group underwent the open reduction and mini-plate internal fixation via the sinus tarsi incision,followed by the postoperative analgesia treatment,while the control group was given the open reduction and internal fixation via the traditional"L-shaped"and following postoperative analgesia treatment. The two groups were compared the average operation time, intraoperative blood loss, postoperative complications, length of incision, preoperative and postoperative VAS score, as well as the calcaneal height,length,and width,the B?hler angle,Gissane angle and calcaneal varus angle before and 3 months after the operation. Six months after the operation,both groups were evaluated the foot function using American Orthopaedic Foot & Ankle Society(AOFAS) and Maryland foot scores.Results Significant differences were observed in the average operation time and intraoperative blood loss between the two groups(P<0.05). The average incision length of the experimental group was significantly shorter than the control group(P>0.05). The postoperative VAS score of the two groups reduced significantly(P<0.05). The average length,width and height,B?hler angle and Gissane angle of the calcaneus of both groups improved significantly after the operation,but there was no significant difference in the improvement between the two groups(P<0.05). The average Maryland and AOFAS scores of the two groups were higher than before the operation,but there was no significant difference between the two groups(P<0.05). However,there was a significant difference in the incidence of postoperative complications between the two groups(P<0.05).Conclusion The treatment of Sanders Ⅱ and Ⅲ calcaneal fractures with micro plate internal fixation via tarsal sinus approach can significantly shorten the operation time,reduce the amount of intraoperative blood loss and the incidence of postoperative complications,and speed up the recovery of the foot function. Compared with the traditional "L" approach,it has better therapeutic effect.