跗骨窦入路联合Herbert螺钉及微创型跟骨锁定钢板治疗SandersⅡ型及Ⅲ型跟骨骨折

Clinical study of sinus tarsal approach combined with Herbert screw and minimally invasive calcaneal locking plate in the treatment of SandersⅡandⅢcalcaneal fractures

目的:探讨跗骨窦入路联合Herbert螺钉及微创型跟骨锁定钢板,对比传统外侧“L”形切口入路联合钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床效果。方法:选取2018年3月至2020年3月收治的110例SandersⅡ、Ⅲ型跟骨骨折患者,男66例,女44例,年龄20~72(48.82±8.03)岁;SandersⅡ型48例,Ⅲ型62例;其中左侧41例,右侧69例。依照手术入路方式将患者分为跗骨窦入路组和“L”形切口入路组,每组55例。“L”形切口入路组采用传统外侧“L”形切口入路联合钢板内固定治疗,跗骨窦入路组采用跗骨窦入路联合Herbert螺钉及微创型跟骨锁定钢板治疗。记录患者手术时间、术中出血量、住院时间、骨折愈合时间评价手术效果。采用X线检查患者手术前后的Bohler角、Gissane角,跟骨长度、宽度、高度,评价手术复位情况。采用美国矫形外科足踝协会(American Orthopedic Foot and Ankle Society,AOFAS)Maryland评分量表评估患者足功能恢复情况,记录患者术后并发症发生情况。结果:所有患者随访至术后12个月,跗骨窦入路组患者手术时间、住院时间均短于“L”形切口入路组(P<0.05),术中出血量低于“L”形切口入路组(P<0.05);术后12个月,两组患者Bohler角、Gissane角、跟骨长度和高度较术前升高(P<0.05),跟骨宽度较术前降低(P<0.05);术后12个月,两组Maryland评分较术前升高(P<0.05)。随访期间,跗骨窦入路组术后并发症(切口感染、关节疼痛、软组织损伤)发生率低于“L”形切口入路组(P<0.05)。结论:传统外侧“L”形切口入路与跗骨窦入路治疗SandersⅡ、Ⅲ型跟骨骨折疗效均较好,但后者能够缩短手术治疗时间,减少并发症的发生。

Objective:To investigate the clinical effect of the tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate compared with traditional lateral L-shaped incision approach combined with plate internal fixation in the treatment of SandersⅡandⅢcalcaneal fractures.Methods:Total of 110 patients with SandersⅡandⅢcalcaneal fractures admitted from March 2018 to March 2020 were selected.There were 66 males and 44 females,ranging in age from 20 to 72 years old,with an average of(48.82±8.03)years old.There were 48 SandersⅡpatients and 62 SandersⅢpatients,including 41 left calcaneal fractures and 69 right calcaneal fractures.According to the surgical approach,the patients were divided into the tarsal sinus approach group and the L-shaped incision approach group,55 cases in each group.The L-shaped incision approach group was treated with traditional lateral L-shaped incision approach combined with internal fixation plate,while the sinus tarsal approach group was treated with tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate.The operative time,intraoperative blood loss,length of hospital stay and time of fracture healing were recorded to evaluate the surgical effect.The Bohler angle,Gissane angle,calcaneal length and width of the patients before and after surgery were examined by X-ray and the surgical reduction was highly evaluated.Foot function recovery was evaluated by American Orthopedic Foot and Ankle Society(AOFAS)Maryland Scale,and postoperative complications were recorded.Results:All patients were followed up to 12 months after surgery,the operation time and hospitalization time of patients in the sinus tarsal approach group were shorter than those in the L-shaped incision approach group(P<0.05),and the amount of intraoperative blood loss was lower than that in the L-shaped incision approach group(P<0.05).One year after surgery,Bohler angle,Gissane angle,calcaneus length and height were increased(P<0.05),calcaneus width was decreased(P<0.05).One year after the operation,the Maryland scores of the two groups were increased(P<0.05).During the follow-up period,the incidence of postoperative complications(incision infection,joint pain,soft tissue injury)in the sinus tarsalapproach group was lower than that in the L-shaped incision approach group(P<0.05).Conclusion:The traditional lateral L-shaped incision approach and the tarsal sinus approach are both good for the treatment of SandersⅡandⅢcalcaneal fractures,but the latter can shorten the surgical treatment time and reduce the incidence of complications.