闭合复位后经皮空心钉与微创纵向入路接骨板内固定治疗跟骨关节内舌型骨折的疗效比较

Comparison of percutaneous cannulated screw fixation and plating via minimally invasive longitudinal approach after closed reduction in treatment of intra-articular tongue-type calcaneal fractures

目的比较闭合复位后经皮空心钉内固定与微创纵向入路接骨板内固定治疗跟骨关节内舌型骨折的疗效。方法回顾性分析2017年5月至2020年5月北京大学第三医院骨科收治的67例跟骨关节内舌型骨折患者资料。男56例,女11例;年龄19~58岁,平均34.5岁。根据治疗方法不同分为2组:空心钉组32例(采用闭合复位后经皮空心钉内固定)和接骨板组35例(闭合复位后微创纵向入路接骨板内固定)。记录并比较两组患者手术时间、受伤至手术时间、术后住院时间、术中出血量及并发症发生情况,术前、术后即刻、术后3个月和末次随访时Gissane角、Bohler角、跟骨长度、宽度、高度、跟骨内翻角和疼痛视觉模拟评分(VAS);术后3个月和末次随访时采用美国足踝外科学会(AOFAS)踝-后足评分进行功能评价。结果空心钉组与接骨板组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获15~25个月(平均18.5个月)随访。空心钉组和接骨板组手术时间分别为60.5(51.5,68.0)、86.0(78.0,96.0)min,术中出血量分别为10.0(5.0,20.0)、20(15.0,25.0)mL,术后住院时间分别为1.0(1.0,1.8)、2(2.0,3.0)d,术后即刻跟骨宽度分别为(43.8±4.4)、(40.6±2.8)mm,术后3个月跟骨宽度分别为43.8(39.6,48.3)、41.5(38.8,44.5)mm,末次随访时跟骨宽度分别为44.2(40.2,48.0)、41.3(39.0,44.3)mm,术后即刻VAS评分分别为5.0(5.0,5.0)、6.0(5.0,6.0)分,以上项目两组间比较差异均有统计学意义(P<0.05)。而两组间跟骨长度、高度、Gissane角、Bohler角、跟骨内翻角以及AOFAS踝-后足评分差异均无统计学意义(P>0.05)。结论跟骨舌型骨折经闭合复位后,与微创纵向入路接骨板内固定相比,经皮空心钉内固定可缩短手术时间和术后住院时间,减少术中出血量,减轻术后疼痛,但微创纵向入路接骨板内固定在恢复跟骨宽度方面更具优势。

Objective To compare percutaneous cannulated screw(PCS)fixation and plating via a minimally invasive longitudinal approach(MILA)after closed reduction for the treatment of intra-articular tongue-type calcaneal fractures.Methods A retrospective analysis was conducted of the 67 patients with intra-articular tongue-type calcaneal fracture who had been treated at Department of Orthopedics,The Third Hospital of Peking University from May 2017 to May 2020.They were 56 males and 11 females,19 to 58 years of age(average,34.5 years).Of them,32 were treated by the PCS fixation after closed reduction(PCS group)and 35 by the MILA plating after closed reduction(MILA group).The operation time,preoperative time,post-operative hospital stay,blood loss and postoperative complications were recorded and compared between the 2 groups.The calcaneal length,width and height,Gissane angle,Böhler angle,varus angle,valgus angle and visual analog scale(VAS)were compared between the 2 groups at preoperation,immediate postoperation,3 months postoperation,and the last follow-up.The American Orthopaedic Foot and Ankle Society(AOFAS)hindfoot score was used at 3 months postoperation and the last follow-up to evaluate the function of the injured hindfoot.Results There was no significant difference in the preoperative general data between the PCS group and the MILA group,showing they were comparable(P>0.05).All patients were followed up for an average of 18.5 months(from 15 to 25 months).For the PCS group and the MILA group,respectively,the operation time was 60.5(51.5,68.0)min and 86.0(78.0,96.0)min,the blood loss 10(5.0,20.0)mL and 20(15,25)mL,the postoperative hospital stay 1(1.0,1.8)d and 2(2,3)d,the calcaneal width at immediate postoperation(43.8±4.4)mm and(40.6±2.8)mm,the calcaneal width at 3 months postoperation 43.8(39.6,48.3)mm and 41.5(38.8,44.5)mm,the calcaneal width at the last follow-up 44.2(40.2,48.0)mm and 41.3(39.0,44.3)mm,the VAS at the last follow-up 5.0(5.0,5.0)and 6.0(5.0,6.0).The comparisons of the above items showed significant differences between the 2 groups(all P<0.05).No significant differences were observed between the 2 groups in the calcaneal length or height,Gissane or Böhler angle,AOFAS hindfoot score,or complication rate(all P>0.05).Conclusions In the treatment of tongue-type calcaneal fractures,after closed reduction,the PCS fixation can shorten operation time and postoperative hospital stay,and reduce intraoperative blood loss and postoperative pain,but the MILA plating is more advantageous in restoring the calcaneal width.