外侧L形入路治疗SandersⅣ型跟骨骨折的手术疗效分析

Analysis of surgical effects of lateral L-shaped approach in the treatment of Sanders typeⅣcalcaneal fractures

目的分析采用外侧L形入路治疗SandersⅣ型跟骨骨折的手术疗效及手术技巧。方法回顾性分析2016年1月至2020年1月首都医科大学附属北京友谊医院采用外侧L形入路治疗SandersⅣ型跟骨骨折的45例病例资料。分析术前术后影像学资料及足踝关节功能恢复情况。随访以门诊随访形式进行。患者术后随访内容主要包括:疼痛视觉模拟评分法(VAS)、美国骨科医师足踝学会(AOFAS)踝-后足功能评分、生活质量评价量表(SF-36)。同时观察并记录患者手术相关并发症发生情况。结果所有患者均得到随访,平均随访13.8个月,骨折均愈合。本组患者术后1个月及术后1年AOFAS评分为(75.4±9.8)、(89.0±7.3)分,均较前次随访时间点[(65.0±12.5)分]明显升高,术后1个月及术后1年SF-36评分为(80.0±3.6)、(95.0±2.5)分,均较前次随访时间点[(70.0±5.5)分]明显升高,术后1个月及术后1年VAS评分为(5.2±2.5)、(2.5±1.2)分,均较前次随访时间点[(8.5±1.5)分]明显降低,差异均有统计学意义(P<0.001)。本组患者术后无伤口感染病例,伤口延迟愈合2例,通过伤口换药在术后5周时愈合。结论采用外侧L形入路治疗SandersⅣ型骨折手术疗效满意,注重术中软组织管理和围手术期康复可以显著改善踝和后足功能、减轻患者术后疼痛,从而获得满意的手术疗效。

Objective To analyze the surgical effects and techniques of lateral L-shaped approach in the treatment of Sanders typeⅣcalcaneal fractures.Methods The data of 45 cases of Sanders typeⅣcalcaneal fracture treated by lateral L-shaped approach in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to January 2020 were analyzed retrospectively.The preoperative and postoperative imaging data and the functional recovery of the affected limb were analyzed.Outpatient follow-up included:visual analog score(VAS),American Orthopaedic Foot Ankle Society(AOFAS)ankle-hindfoot score and short form health survey(SF-36).The operation-related complications were observed and recorded.Results All patients were followed up for an average of 13.8 months.The AOFAS scores of the patients in this group were(75.4±9.8)and(89.0±7.3)points at 1 month after operation and 1 year after operation,which were significantly higher than that at the previous follow-up time[(65.0±12.5)points].The SF-36 scores at 1 month and 1 year after surgery were(80.0±3.6)and(95.0±2.5)points,which were significantly higher than that at the previous follow-up time[(70.0±5.5)points],the VAS scores of(5.2±2.5)and(2.5±1.2)points at 1 month after surgery and 1 year after operation were significantly lower than that at the previous follow-up time[(8.5±1.5)points],and the differences were statistically significant(P<0.001).There were no wound infections in this group of patients,2 cases of delayed wound healing,wound healing at 5 weeks postoperatively through dressing change.Conclusion The curative effect of Sanders typeⅣfracture treated by lateral L-shaped approach is satisfactory.Paying attention to intraoperative soft tissue management and perioperative rehabilitation can significantly improve the function of ankle and hindfoot and reduce postoperative pain,so as to obtain satisfactory surgical effect.