距下关节镜联合跟腱前外侧纵向切口锁定钢板内固定治疗跟骨关节内移位骨折

Subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon for treatment of displaced intra-articular calcaneal fractures

目的探讨距下关节镜联合跟腱前外侧纵向切口锁定钢板内固定治疗跟骨关节内移位骨折的临床疗效。方法采用回顾性病例系列研究分析2016年1月至2018年5月徐州市中心医院收治的38例(38足)跟骨关节内移位骨折患者的临床资料,其中男21例(21足),女17例(17足);年龄21~53岁[(33.7±6.2)岁]。依据Sanders分型:Ⅱ型7例,Ⅲ型27例,Ⅳ型4例。均采用距下关节镜联合跟腱前外侧纵向切口锁定钢板内固定治疗。观察并记录手术时间、术中处理情况、伤口愈合情况、术后神经/血管/肌腱损伤等并发症情况,术前、术后第2天及末次随访时观察Bhler角、Gissane角、跟骨的长度/宽度/高度及骨折愈合情况。术前及末次随访时采用视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分、踝关节功能评分(FAOS)对临床效果及踝关节功能进行评价。结果患者均获随访12~42个月[(18.7±5.3)个月]。手术时间为45~100 min[(72.4±22.6)min]。无一例植骨,术中出现跟骨后关节面微骨折9例。切口均获得Ⅰ期愈合。未出现早期神经、血管和肌腱损伤等并发症。末次随访时Bhler角、Gissane角、跟骨长度/宽度/高度较术前显著改善(P<0.01),与术后第2天比较,差异均无统计学意义(P>0.05)。末次随访时所有患者骨折获得愈合,无畸形或骨髓炎。末次随访时VAS由术前5(3,9)分降至0(0,3)分,AOFAS踝-后足评分由术前(68.3±10.5)分提高至(90.6±5.0)分,FAOS由术前(66.9±9.1)分提高至(89.8±4.3)分(P<0.01)。AOFAS踝-后足评分:优27例,良8例,中3例,优良率为92%。结论对于跟骨关节内移位骨折,采用距下关节镜联合跟腱前外侧纵向切口的锁定钢板内固定治疗,复位精准,术后并发症发生率低,功能恢复满意。

To investigate the clinical outcomes of subtalar arthroscopy combined with locking;plate fixation through anterolateral longitudinal incision of the Achilles tendon in treating displaced intra-articular calcancal fractures.Methods A retrospective case-series study was performed to analyzed thedata of 38 patients(38 feet)with displaced intra-articular calcaneal fractures admitted to Xuzhou CentralHospital from January 2016 to May 2018.There were 21 males(21 feet)and 17 females(17 feet),with the age of(33.7±6.2)years(range,21-53 years).Accordling to the Sanders’classification,7 patientswere classified as type Ⅱ,27 as type Ⅲ and 4 as type Ⅳ.All patients underwent the procedure of subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon procedure.The operation time,intro-operative management,incision healing,and post-operative complications(nerve,vessels and tendon injuries)were recorded.Bohler angle,Gissane angle,length,with and height of the calcaneus,and bone healing time were recorded at postoperative 2 days and at final follow-up.The visual analogue score(VAS),American Orthopaedic Foot&Ankle Society(AOFAS)ankle and hindfoot scale,and Foot and Ankle Outcome Score(FAOS)were recorded at final follow-up,and were used to evaluate the clinical and functional outcomes.Results All patients were followed up for 12-42 months[(18.7±5.3)months].The operaion time ranged from 45 to 100 minutes[(72.4±22.6)minutes].Bone grafting was not observed,and microfracture of the posterior articular surface of the calcaneus were involved in 9 patients.The first-stage incision healing was achieved in all patients,without early complications of nerve,vessel and tendon injuries.The post-operative angles of Bohler and Gissane,length,width and height of the calcaneus were significantly improved compared to preoperative values(P<0.01),while there were no significant difference at postoperative 2 days and at final fllowup(P>0.05),At final follow-up,the VAS decreased from 5(3,9)points to 0(0,3)points,AOFAS improved from(68.3±10.5)points to(90.6±5.0)points,and FAOS improved from(66.9±9.1)points to(89.8±4.3)points,respectively(P<0.01).According to the AOFAS ankle aund himdfoo scale,the result was excellent in 27 patients,good in8,and fair in 3,with the excellent and good rate of 92%。Conclusions For displaced intra-articular calcaneal fractures,subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon has advantages of precise fracture reduction,low postoperative complications and reliable functional outcomes.