经跗骨窦入路复位钢板固定、L形切口复位内固定治疗跟骨骨折的临床应用比较

Comparison of clinical application of reduction and plate fixation via the sinus tarsi approach and L-shaped incision reduction and internal fixation in the treatment of calcaneal fractures

目的探讨经跗骨窦入路复位钢板固定、L形切口复位内固定治疗跟骨骨折的临床效果。方法选取跟骨骨折患者96例的临床资料,进行回顾性研究。根据治疗方案不同分为跗骨窦组和L形组,每组48例。跗骨窦组采用经跗骨窦入路复位钢板固定治疗,L形组采用L形切口复位内固定治疗。比较2组手术情况、术后康复情况、手术优良率、并发症发生情况,比较2组手术前后血清创伤应激-炎症指标[超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malonaldehyde,MDA)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)]、转化生长因子β(transforming growth factor-β,TGF-β)/骨形态发生蛋白(bone morphogenetic proteins,BMPs)信号通路指标(TGF-β1、BMP-2、BMP-7)。结果跗骨窦组手术时间、住院时间、骨折愈合时间均短于L形组,术中出血量、术中透视次数、术后引流量均少于L形组(P<0.05)。随治疗时间延长,2组血清SOD水平呈先降低后升高趋势,MDA、TNF-α水平呈先升高后降低趋势,跗骨窦组波动幅度小于L形组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组血清TGF-β1、BMP-2、BMP-7水平呈逐渐升高趋势,跗骨窦组血清TGF-β1、BMP-2、BMP-7水平高于L形组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组手术优良率差异无统计学意义(P>0.05)。跗骨窦组并发症总发生率低于L形组(P<0.05)。结论与L形切口复位内固定比较,经跗骨窦入路复位钢板固定治疗跟骨骨折能减少手术创伤、缩短手术时间,减轻手术创伤引起的应激、炎症反应,降低并发症发生率,进一步改善患者TGF-β/BMPs信号通路指标表达水平,促进术后康复,临床应用价值更高。

Objective To investigate the clinical effect of reduction and plate fixation via the sinus tarsi approach and L-shaped incision reduction and internal fixation in the treatment of calcaneal fractures.Methods The clinical data of 96 patients with calcaneal fractures were selected for a retrospective study.According to different treatment plans,they were divided into tarsi sinus group and L-shaped group,with 48 cases in each group.The tarsal sinus group was treated with reduction and plate fixation via the tarsal sinus approach,and the L-shaped group was treated with L-shaped incision reduction and internal fixation.Surgical condition,postoperative recovery,excellent and good rate of surgery,and the incidence of complications were compared between two groups.Serum traumatic stress-inflammatory indexes[superoxide dismutase(SOD),malonaldehyde(MDA),tumor necrosis factor-α(TNF-α)],transforming growth factor-β(TGF-β)/bone morphogenetic proteins(BMPs)signaling pathway indicators(TGF-β1,BMP-2,BMP-7)before and after surgery were compared between two groups.Results The duration of operation,length of hospital stay,and fracture healing time were shorter in the tarsal sinus group than in the L-shaped group,and the intraoperative bleeding,intraoperative fluoroscopy,and postoperative drainage were less than those in the L-shaped group(P<0.05).With the prolongation of treatment time,the serum SOD level of the two groups showed a trend of decreasing and then increasing,while the MDA and TNF-αlevels showed a trend of increasing and then decreasing.The fluctuation of the tarsal sinus group was smaller than that of the L-shaped group,and the differences of interaction between groups,time points and time point between groups were statistically significant(P<0.05).The serum TGF-β1,BMP-2,and BMP-7 levels in the two groups showed a gradual increase,and the serum TGF-β1,BMP-2,and BMP-7 levels in the tarsal sinus group were higher than those in the L-shaped group(P<0.05).The difference in the excellent and good rate of surgery between two groups was not statistically significant(P>0.05).The overall complication rate was lower in the tarsal sinus group than in the L-shaped group(P<0.05).Conclusion Compared with L-shaped incision reduction and internal fixation,reduction and plate fixation via the sinus tarsi approach in the treatment of calcaneal fractures can reduce surgical trauma,shorten the duration of operation,reduce stress and inflammation reactions caused by surgical trauma,reduce the incidence of complications,further improve the expression level of TGF-β/BMPs signaling pathway indexes in patients,and promote postoperative recovery,which is of higher application value in clinical practice.