跗骨窦入路结合围手术期中医药干预治疗SandersⅡ~Ⅲ型跟骨骨折的效果

Therapeutic effect of tarsal sinus approach combined with perioperative intervention of traditional Chinese medicine on Sanders Ⅱ-Ⅲ calcaneal fracture

目的 研究跗骨窦入路、外侧L形入路切开复位内固定治疗SandersⅡ~Ⅲ型跟骨骨折的实际效果,并对治疗策略加以讨论分析。方法 回顾性分析2017年12月至2019年12月于聊城市中医医院骨伤科行切开复位内固定治疗的SandersⅡ~Ⅲ型跟骨骨折患者84例。根据治疗方式不同分为跗骨窦入路组和外侧L形入路组,并给予中医药围手术期干预。记录患者术前以及术后24 h、2个月、1年的X线检查,以Gissane角、Bohler角及美国足与踝关节协会(AOFAS)踝-后足评分为指标,随访术后并发症,进行组间比较分析。结果 手术均顺利完成,无1例脱访。跗骨窦入路组手术时间、术后失血量均低于外侧L形入路组,差异有统计学意义(P <0.05);无1例出现腓肠神经损伤、切口皮缘坏死,但两组各有1例在术后出现创口皮肤轻微感染,给予药物治疗后症状消失,并发症总发生率无差异。在术后随访时间范围内,两组AOFAS踝-后足评分均大幅提高,差异有统计学意义(P <0.05);术后2个月,跗骨窦入路组AOFAS踝-后足评分高于外侧L形入路组,差异有统计学意义(P <0.05);末次随访,两组AOFAS踝-后足评分比较,差异无统计学意义(P> 0.05)。影像学检查结果示,末次随访,两组跟骨B?hler角和Gissane角较术前均有所提高,差异有统计学意义(P <0.05);术前及末次随访,两组跟骨Bohler角和Gissane角比较,差异无统计学意义(P> 0.05)。结论 通过采用规范化的中医药围手术期干预,对于SandersⅡ~Ⅲ型跟骨骨折患者,无论是跗骨窦入路插入锁定钢板亦或外侧L形入路治疗,均能实现良好的效果,两组并发症发生率相同,短期内跗骨窦入路组的疗效评分优于外侧L形入路组,远期随访评分差异不大。

Objective To investigate the actual effect of open reduction and internal fixation(ORIF) by tarsal sinus approach and lateral L-shaped approach in the treatment of Sanders Ⅱ-Ⅲ calcaneal fracture, and discuss and analyze the treatment strategy. Methods A total of 84 patients with Sanders Ⅱ-Ⅲ calcaneal fracture treated by open reduction and internal fixation in the Department of Orthopaedics of Hospital of Traditional Chinese Medicine of Liaocheng City from December 2017 to December 2019 were retrospectively analyzed. They were divided into the tarsal sinus approach group and the lateral L-shaped approach group according to different treatment methods, and were given perioperative intervention of traditional Chinese medicine(TCM). The X-ray examinations of the patients before operation, 24 h after operation, 2 months after operation and 1 year after operation were recorded. The postoperative complications were followed up and compared between the two groups, with Gissane angle, Bohler angle and American Orthopaedic Foot &Ankle Society(AOFAS) ankle-hindfoot score used as indicators. Results All the operations were successfully completed, and none of them was lost to follow-up. The operation time and postoperative blood loss in the tarsal sinus approach group were lower than those in the lateral L-shaped approach group, and the difference was statistically significant(P < 0.05). None of the patients had sural nerve injury and incision skin margin necrosis, but one patient in the two groups had mild infection of wound skin after operation, and the symptoms disappeared after medication. The incidence of complications was the same, with no significant difference between the two groups. Within the follow-up time after operation, the AOFAS ankle-hindfoot scores of both groups were significantly improved, and the difference was statistically significant(P < 0.05). At two months after operation, the AOFAS ankle-hindfoot score was higher in the tarsal sinus approach group than that in the lateral L-shaped approach group, and the difference was statistically significant(P < 0.05). At the last follow-up, there was no significant difference in AOFAS score between the two groups(P > 0.05). The imaging examinations showed that the Bohler angle and Gissane angle of calcaneus were improved compared with those before operation in the two groups at the last follow-up, and the difference was statistically significant(P < 0.05). There were no significant difference in B?hler angle and Gissane angle of calcaneus between the two groups before operation and at the last follow-up(P > 0.05). Conclusion For patients with Sanders Ⅱ-Ⅲ calcaneal fracture, whether internal fixation with steel plate by the tarsal sinus approach or the lateral L-shaped approach, the standardized perioperative intervention of TCM can achieve good results. The incidence of complications of the two groups is the same. The short-term therapeutic effect score of the tarsal sinus approach group is better than that of the lateral L-shaped approach group, and their long-term follow-up scores are not significantly different.