距下关节镜辅助下经皮撬拨复位螺钉固定与切开复位内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的对比研究

A Comparative Study of Subtalar Arthroscopy Assisted Percutaneous Poking Reduction Screw Fixation Versus Open Reduction and Internal Fixation in the Treatment of SandersⅡandⅢCalcaneal Fractures

目的探讨关节镜辅助下经皮撬拨复位螺钉固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法回顾性比较我科2010年8月~2019年10月97例新鲜闭合性跟骨骨折的临床资料,根据手术方式不同分为传统切开组和关节镜辅助微创组,比较2组患者术前等待时间、术中出血量、术后切口并发症(切口皮肤坏死和切口周围皮肤麻木)发生率、美国足踝矫形外科协会(American Orthopedic Foot and Ankle Society,AOFAS)评分和Maryland评分。结果关节镜辅助微创组术前等待时间(1.3±0.4)d,明显短于传统切开组(8.0±0.7)d(t=57.067,P=0.000);术中出血量(17.8±3.1)ml,明显少于传统切开组(55.8±4.9)ml(t=46.143,P=0.000);术后皮肤坏死、皮肤麻木发生率明显低于传统切开组[0 vs.37.0%(20/54),P=0.000;2.3%(1/43)vs.50.0%(27/54),χ^(2)=26.497,P=0.000];AOFAS评分(93.6±2.5)分,明显高于传统切开组(81.7±3.1)分(t=-20.407,P=0.000);Maryland评分(93.0±2.4)分,明显高于传统切开组(81.3±3.1)分(t=-21.112,P=0.000)。2组患者跟骨长度、宽度、高度和Bohler角手术后均明显恢复(均P=0.000),传统切开组术后1年跟骨长度、宽度、高度和Bohler角与术后即刻比较有明显丢失(均P=0.000),关节镜辅助微创组术后1年与术后即刻比较丢失不明显(均P=1.000)。结论距下关节镜辅助下经皮撬拨复位螺钉固定与切开复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折比较,可以缩短患者术前等待时间和手术时间,降低术中出血及术后并发症发生率。

Objective To investigate the efficacy of subtalar arthroscopy assisted percutaneous poking reduction screw fixation in the treatment of SandersⅡandⅢcalcaneal fractures.Methods We retrospectively studied the data of 97 patients with fresh closed calcaneal fractures admitted to our department from August 2010 to October 2019.According to surgical methods,they were divided into traditional open group and the arthroscopy assisted minimally invasive group.The preoperative waiting time,operation time,intraoperative blood loss,postoperative incision complications(skin necrosis of incision and the surrounding skin incision numbness),American Orthopedic Foot and Ankle Society(AOFAS)score and Maryland score were compared between the two groups.Results The waiting time before operation in the arthroscopy assisted minimally invasive group was(1.3±0.4)d,significantly shorter than that in the traditional open group[(8.0±0.7)d,t=57.067,P=0.000];the intraoperative blood loss was(17.8±3.1)ml,significantly less than that in the traditional open group[(55.8±4.9)ml,t=46.143,P=0.000];the incidence of postoperative skin necrosis and numbness in the arthroscopy assisted minimally invasive group was significantly lower than that in the traditional incision group[0 vs.37.0%(20/54),P=0.000;2.3%(1/43)vs.50.0%(27/54),χ^(2)=26.497,P=0.000];the AOFAS score(93.6±2.5)points was significantly higher than that of the traditional open group(81.7±3.1)points(t=-20.407,P=0.000);the Maryland score(93.0±2.4)points was significantly higher than that of the traditional open group(81.3±3.1)points(t=-21.112,P=0.000).The length,width,height and Bohler angle of the calcaneus in the two groups were significantly restored after operation(all P=0.000).The length,width,height and Bohler angle of the calcaneus in the traditional open group were significantly lost one year postoperatively as compared with those immediately after operation(all P=0.000),and the loss in the arthroscopy assisted minimally invasive group had no significant differences as compared with those immediately after operation(all P=1.000).Conclusion Compared with open reduction and internal fixation in the treatment of sandersⅡandⅢcalcaneal fractures,subtalar arthroscopy assisted percutaneous poking reduction screw fixation can shorten the preoperative waiting time and operation time,and reduce the incidence of intraoperative bleeding and postoperative complications.