两种切口开放复位内固定跟骨骨折的比较

Comparison of two incisions for open reduction and internal fixation of calcaneus fractures

[目的]比较两种切口开放复位内固定治疗关节内跟骨骨折的临床疗效。[方法]2016年3月—2020年1月,本科室手术治疗跟骨骨折35例。采用随机数字表法将患者分为两组。所有患者均接受开放复位内固定术,微创组16例,采用跗骨窦切口;常规组19例,采用常规外侧L形切口。比较两组围手术期、随访和影像资料。[结果]微创组手术时间、术中失血量、切口长度、切口愈合等级、住院时间均显著优于常规组(P<0.05),但术中透视次数明显多于常规组(P<0.05)。35例患者均获随访12个月以上。两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组VAS评分均显著减少(P<0.05),而AOFAS和Maryland评分均显著增加(P<0.05)。相应时间点,两组间上述评分的差异均无统计学意义(P>0.05)。影像方面,两组骨折均愈合良好,末次随访时两组跟骨宽度、高度、长度、Gissane角及B?hler角术均较术前明显改善(P<0.05),两组间影像测量指标的差异均无统计学意义(P>0.05)。[结论]两种手术方式治疗关节内跟骨骨折均获得良好临床效果,相比之下,跗骨窦切口的手术创伤更小。

[Objective]To compare the clinical efficacy of two incisions for open reduction and internal fixation(ORIF)in the treatment of intraarticular calcaneus fractures.[Methods]From March 2016 to January 2020,a total of 35 patients received surgical treatment for calcaneal fractures in our department.The patients were divided into two groups by random number table method,and received ORIF.Of them,16 patients in the minimally invasive group had ORIF performed through tarsal sinus incision,while the other 19 patients in the conventional group were through the conventional lateral L-shaped incision.The perioperative,follow-up and imaging data were compared between the two groups.[Results]The minimally invasive group proved significantly superior to the conventional group in terms of operation time,blood loss,incision length,incision healing and hospital stay(P<0.05),but the former had significantly greater number of intraoperative fluoroscopy than the latter(P<0.05).All the 35 patients were followed up for more than 12 months.There was no statistically significant difference in the time to return to full weight-bearing activity between the two groups(P>0.05).The VAS scores decreased significantly(P<0.05),whereas the AOFAS and Maryland scores increased significantly over time in both groups(P<0.05).At any corresponding time points,there was no significant difference in the above scores between the two groups(P>0.05).Radiographically,all patients in both groups got fracture healing well,with significant improvements of calcaneal width,height,and length as well as Gissane angle and Bohler angle at the latest follow-up compared with those preoperatively(P<0.05).However,there was no significant difference in aforesaid imaging measures between the two groups at any matching time points(P>0.05).[Conclusion]Both tarsal sinus incision and the conventional lateral L-shaped incision for ORIF of intra-articular calcaneal fractures achieve satisfactory clinical outcomes,by comparison,the tarsal sinus incision has a benefit of minimizing iatrogenic trauma.