跟骨骨折中跗骨窦入路与外侧延长切口入路治疗效果及影像学参数比较

Comparison of therapeutic effects and imaging parameters between tarsal sinus approach and extended lateral approach in the treatment of calcaneal fractures

目的评估和比较跗骨窦入路(sinus tarsi approach,STA)和外侧延长切口入路(extended lateral approach,ELA)治疗SandersⅡ~Ⅲ型跟骨骨折患者的临床功能,影像学参数和术后并发症。方法选取我院在2018年4月至2020年5月行STA或ELA切开复位内固定术治疗的104例SandersⅡ~Ⅲ型跟骨骨折患者。52例行STA切开复位内固定术(STA组),52例行ELA切开复位内固定术(ELA组)。临床功能评估主要依据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分,疼痛视觉模拟评分(visual analogue scale,VAS)和简明健康调查量表(short form-36 health survey,SF-36)。影像学参数主要依据Boehler角,Gissane角以及跟骨的长、高和宽。根据术后CT扫描结果评估复位质量。结果两组患者术后跟骨侧位和轴位X线片显示骨折复位固定较术前良好,术后Bohler角、Gissane角、跟骨宽度、长度、高度均较术前得到明显矫正(P>0.05)。STA组患者SF-36-躯体健康(SF-36-physical component summary,SF-36-PCS)和SF-36-精神健康(SF-36-mental component summary,SF-36-MCS)评分高于ELA组患者(P<0.05)。STA组患者整体复位质量与ELA组相当(P>0.05),SandersⅢ型骨折亚组中,ELA组患者整体复位质量优于STA组患者(P<0.05)。STA组患者术后并发症总发生率低于ELA组患者(11.5%vs.44.2%,P<0.001)。其中,STA组患者切口并发症(3.8%vs.15.4%)及腓肠神经损伤(1.9%vs.9.6%)发生率低于ELA组患者(P<0.05)。结论STA和ELA在治疗SandersⅡ~Ⅲ型跟骨骨折患者时,均具有满意的临床治疗效果。但需要根据患者具体情况制订手术入路方案,强调STA完全替代ELA尚缺乏临床证据。

Objective To evaluate and compare the clinical function,imaging parameters and postoperative complications of tarsal sinus approach(STA)and extended lateral approach(ELA)in the treatment of SandersⅡ-Ⅲcalcaneal fractures.Methods A total of 104 patients with SandersⅡ-Ⅲcalcaneal fracture were selected,all underwent open reduction and internal fixation with STA(52 cases)or ELA(52 cases)from April 2018 to May 2020.Clinical function evaluation was mainly based on the American Orthopaedic Foot and ankle Association(AOFAS)score,visual analogue scale(VAS)and Short Form-36 Health Survey(SF-36).Imaging parameters were mainly based on Boehler angle,Gissane angle,and the length,height and width of the calcaneus.The quality of reduction was evaluated according to the results of postoperative CT scan.Results The lateral and axial films of the calcaneus in the two groups showed that the fracture reduction and fixation were better than that before operation,and the Bohler angle,Gissane angle,calcaneal width,length and height were significantly corrected after operation(P>0.05).The scores of SF-36-physical component summary(SF-36-PCS)and SF-36-mental component summary(SF-36-MCS)in STA group were higher than those in ELA group(P<0.05).The overall reduction quality of STA group was equivalent to that of ELA group(P>0.05).In SandersⅢfracture subgroup,the overall reduction quality of ELA group was better than that of STA group(P<0.05);the total incidence of postoperative complications in STA group was lower than that in ELA group(11.5%vs.44.2%,P<0.001).The incidence of incision complications(3.8%vs.15.4%)and sural nerve injury(1.9%vs.9.6%)in STA group was lower than that in ELA group(P<0.005).Conclusions Both STA and ELA achieve satisfactory clinical effect in the treatment of SandersⅡ-Ⅲcalcaneal fracture.However,it is necessary to formulate a surgical approach plan according to the specific situation of the patient,rather than replace ELA by STA directly.