经跗骨窦切口入路手术治疗跟骨骨折的复位效果观察

Observation on the Reduction Effect of the Surgery Through Lateral L-shaped Incision Approach in the Treatment of Calcaneal Fractures

目的:探讨经跗骨窦切口入路术治疗跟骨骨折的复位效果。方法:选择跟骨骨折患者78例(78足),按照不同手术方式分为观察组(n=39)和对照组(n=39),对照组采用常规外侧L型切口入路手术治疗,观察组采用经跗骨窦切口手术治疗,术后随访12个月。比较2组手术相关指标,术后复位质量(Bohler角、Gissane角、跟骨宽度)、Maryland评分、生活质量(SF-36评分)及并发症发生情况。结果:观察组手术时间[(61.25±5.47)vs(92.18±8.39)min]、住院时间[(5.01±1.67)vs(11.85±1.83)d]、切口愈合时间[(14.35±1.03)vs(16.47±2.19)d]均短于对照组(P<0.05),术中出血量低于对照组[(45.38±4.29)vs(84.64±5.72)mL,P<0.05];术后12个月,2组Bohler角、Gissane角均较术前有明显好转(P<0.05),术后组间差异无统计学意义(P>0.05);2组跟骨宽度均低于术前(P<0.05),术后组间差异无统计学意义(P>0.05);2组Maryland评分优良率(87.18%vs 89.74%)及SF-36评分[(79.42±3.25)vs(80.73±3.64)分]比较,差异无统计学意义(P>0.05);2组创伤性关节炎、切口并发症、皮肤感染发生率比较,差异均无统计学意义(P>0.05)。结论:经跗骨窦切口手术治疗跟骨骨折,能有效缩短手术时间、住院时间、减少术中出血量,利于切口愈合,有较好的复位效果。

Objective:To explore the reduction effect of the surgery through lateral L-shaped incision approach in the treatment of calcaneal fractures.Methods:A total of 78 patients(78 feet)with calcaneal fractures treated in the hospital were enrolled.According to different surgical methods,they were divided into observation group(n=39)and control group(n=39).The control group underwent routine surgery through lateral L-shaped incision approach,while observation group underwent transtarsal sinus incision surgery.After 12 months of postoperative follow-up,surgical related indexes,postoperative reduction quality(Bohler angle,Gissane angle,calcaneal width),scores of Maryland and quality of life(SF-36),and the occurrence of complications were compared between the two groups.Results:The operation time,hospitalization time and incision healing time were shorter in observation group than control group(P<0.05),and intraoperative blood loss was less in observation group than control group(P<0.05).At 12 months after surgery,Bohler angles Gissane angles in both groups were significantly improved compared with those before surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).After surgery,calcaneal width in observation group and control group was reduced(P<0.05),but there was no significant difference between the two groups(P>0.05).At 12 months after surgery,difference in good rate of Maryland score(87.18%vs 89.74%)and SF-36 score between the two groups was not statistically significant(P>0.05).There was no significant difference in the incidence of traumatic arthritis,incision complications or skin infection between observation group and control group(P>0.05).Conclusion:Surgical treatment of calcaneal fractures through transtarsal sinus incision can effectively shorten the operation time,hospital stay,reduce intraoperative blood loss,accelerate incision healing and have a better reduction effect.