“八”字切口入路治疗跟骨骨折临床效果

CLINICAL EFFECT OF“八”SHAPED INCISION APPROACH IN TREATMENT OF CALCANEAL FRACTURE

目的通过与跗骨窦入路对比,评价"八"字切口入路治疗跟骨骨折的效果。方法回顾性分析54例跟骨骨折病人的临床资料。按手术入路不同将病人分为跗骨窦组和"八"字组,比较两组手术时间、术中出血量、术后48 h视觉模拟评分法(VAS)评分、末次随访时的AOFAS踝-后足评分系统评分(AOFAS评分)和Maryland评分、手术前后的Bohler角和Gissane角。结果跗骨窦组和"八"字组病人分别获得了(17.9±3.4)和(19.2±6.3)个月的随访。两组间手术时间、术中出血量、术后48 h VAS评分、末次随访时的AOFAS评分和Maryland评分、术后Bohler角和Gissane角等比较差异均无显著性(P>0.05)。两组病人术后Bohler角和Gissane角与术前相比差异均有统计学意义(t=9.84~13.70,P<0.01)。结论"八"字切口入路与跗骨窦入路具有相同的手术疗效,但前者具有更广阔的视野及操作空间,可以避免术中不必要的软组织挤压,可作为首选方案应用于SandersⅡ、Ⅲ型跟骨骨折的治疗。

Objective To investigate the clinical effect of“八”shaped incision approach versus tarsal sinus approach in the treatment of calcaneal fracture.Methods A retrospective analysis was performed for the clinical data of 54 patients with calcaneal fracture,and according to the surgical approach,they were divided into tarsal sinus group and“八”shaped incision group.The two groups were compared in terms of time of operation,intraoperative blood loss,Visual Analogue Scale(VAS)score at 48 h after surgery,AOFAS Ankle-Hindfoot Scale score and Maryland score at final follow-up,and Bohler angle and Gissane angle before and after surgery.Results The tarsal sinus group was followed up for(17.9±3.4)months,and the“八”shaped incision group was followed up for(19.2±6.3)months.There were no significant differences between the two groups in time of operation,intraoperative blood loss,VAS score at 48 h after surgery,AOFAS score and Maryland score at final follow-up,and Bohler angle and Gissane angle after surgery(P>0.05).Both groups had significant changes in Bohler angle and Gissane angle after surgery(t=9.84-13.70,P<0.01).Conclusion The“八”shaped incision has the same surgical effect as the tarsal sinus approach,and the former has wider field of vision and operating space and can avoid unnecessary soft tissue compression during surgery.Therefore,it can be used as the preferred choice for Sanders typeⅡ/Ⅲcalcaneal fracture.