跟骨内侧定位导向器辅助与徒手置入载距突螺钉治疗移位的跟骨关节内骨折的疗效比较

Comparative study on sustentaculum tali screw placement using the self-designed guider positioning from the medial of the calcaneus and free-hand technique in treating displaced intra-articular calcaneal fracture

目的比较自行研制的跟骨内侧定位导向器辅助与徒手置入载距突螺钉在移位的跟骨关节内骨折(DIACF)治疗中的临床效果。方法采用回顾性病例对照研究分析2016年7月至2018年6月山东大学齐鲁医院(青岛)收治的97例(110足)跟骨关节内骨折患者临床资料,其中男72例,女25例;年龄16~72岁[(41.7±12.7)岁]。均为新鲜骨折。49例(56足)置入载距突螺钉时采用自行研制的导向器辅助(A组),48例(54足)徒手置入载距突螺钉(B组)。比较两组手术时间、载距突螺钉置入精确率及术后并发症;比较两组术前、术后1年跟骨Böhler角和Gissane角;末次随访时,采用Maryland足部评分系统比较两组功能恢复情况。结果患者均获随访3~36个月[(20.1±8.3)个月]。两组手术时间差异无统计学意义(P>0.05)。A组螺钉置入精确率为95%(53/56),明显高于B组的69%(35/54)(P<0.05)。A组术后并发症与B组相近,差异无统计学意义(P>0.05)。A组45例(52足)、B组44例(49足)获得1年以上随访。术前、术后1年跟骨Böhler角和Gissane角两组间比较,差异均无统计学意义(P>0.05);而组内比较,差异有统计学意义(P<0.05)。末次随访时,Maryland足部评分系统评分:A组优38足,良11足,可3足,优良率为94%;B组优26足,良9足,可14足,优良率为71%(P<0.05)。结论跟骨内侧定位导向器辅助置入载距突螺钉治疗DIACF,与徒手置入相比,在不增加手术时间的情况下,可明显提高载距突螺钉置入精确率,促进患者功能恢复。

Objective To compare the clinical effect of sustentaculum tali screw placement for treatment of displaced intra-articular calcaneal fracture(DIACF)by using self-developed calcaneal guider and conventional method.Methods A retrospective case-control study was made on clinical data of 97 patients(110 feet)with fresh DIACF hospitalized in Qilu Hospital(Qingdao)from July 2016 to June 2018.There were 72 males and 25 females,with the age of 16-72 years[(41.7±12.7)years].All were fresh fractures.Group A(49 patients,56 feet)had sustentaculum tali screw placement by using the self-developed calcaneal guider during and Group B(48 patients,54 feet)were fixed by the conventional screw placement method.The operation time,accuracy rate of sustentaculum tali screw placement,postoperative complications,and Bohler angle and Gissane angle before operation and at 1 year after operation were compared between the two groups.The Maryland foot scoring system was applied to evaluate function recovery at final follow-up.Results All patients were followed up for 3-36 months[(20.1±8.3)months].There was no significant difference in operation time between the two groups(P>0.05).The accuracy rate of screw placement in Group A was 95%(53/56),significantly higher than that in Group B[69%(35/54)](P<0.05).The incidence of complications was similar between the two groups(P>0.05).Forty-five patients(52 feet)in Group A and 44 patients(49 feet)in Group B were followed up for more than one year.The Bohler angle and Gissane angle in both groups were significantly improved after operation(P<0.05),while the two angles were not significantly different between the two groups before operation and at 1 year after operation(P>0.05).According to the Maryland foot scoring system,38 feet in Group A achieved excellent result,11 good result,3 fair result,with the excellent and good rate of 94%;26 feet in Group B achieved excellent result,9 good result,14 fair result,with the excellent and good rate of 71%(P<0.05).Conclusion In treatment of DIACF,our self-designed guider can significantly enhance the accuracy rate of sustentaculum tali placement without more operation time and enhance patients'recovery after operation when compared with the free-hand technique.