距下关节镜下联合辅助器械精准微创治疗SandersⅡ、Ⅲ型跟骨骨折

Precise and minimally invasive treatment of Sanders Ⅱ&Ⅲ calcaneal fractures with arthroscopy combined with auxiliary instruments

目的探讨距下关节镜下联合辅助器械精准微创治疗SandersⅡ、Ⅲ型跟骨骨折手术方法及临床疗效。方法回顾性研究2017年8月-2020年1月收治的58例58足闭合性跟骨关节内骨折患者的临床资料,根据治疗方法不同分为关节镜组(29例29足)和微创组(29例29足)。关节镜组采用关节镜下联合辅助器械(国家发明专利)精准微创治疗;微创组采用跗骨窦切口切开复位,微创锁定接骨板内固定。比较两组的术前准备时间、切口长度、手术时间、切口并发症、后足活动度、美国足踝外科协会(AOFAS)后足功能评分;术前、术后、末次随访均行X线及CT检查,测量Bohler角、Gissane角、跟骨宽度,评价骨折复位情况。结果两组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。术后58例均获得随访,随访时间10~18个月,平均(14.30±1.45)个月。关节镜组术前准备时间(2.24±1.33)d、切口长度(1.53±0.97)cm优于微创组(5.62±3.05)d、(4.52±2.03)cm;关节镜组切口并发症(0%)低于微创组(10.34%);后足活动度评分(4.83±1.12)分高于微创组(2.45±0.86)分,差异均有统计学意义(P<0.05)。两组在手术时间、(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足功能评分比较,差异无统计学意义(P>0.05)。影像学分析,两组术后的Bohler角、Gissane角、跟骨宽度均有改善,末次随访,复位无明显丢失;两组术后及末次随访Bohler角、Gissane角、跟骨宽度比较,差异无统计学意义(P>0.05)。结论关节镜下联合辅助器械精准微创治疗SandersⅡ、Ⅲ型跟骨骨折,可明显缩短住院时间,手术过程简单清晰,复位固定精准微创,手术时间短,术后并发症少,骨质血运破坏小,术后骨折愈合快,距下关节无明显僵硬,无需二次手术,临床疗效满意。

Objective To discuss the surgical methods and clinical effects of arthroscopy combined with auxiliary instruments for precise and minimally invasive treatment of Sanders Ⅱ&Ⅲ calcaneal fractures.Methods A retrospective study of 58 patients with closed intra-articular calcaneal fractures of 58 feet in our hospital from August 2017 to January 2020,which were divided into arthroscopy group(29 cases,29 feet)and minimally invasive group(29 cases,29 feet)according to different treatment methods.The arthroscopy group was used arthroscopy combined with auxiliary devices(national invention patents)for precise and minimally invasive treatment.In the minimally invasive group,the sinus tarsal incision was used for open reduction,and the minimally invasive locking bone platewas usedfor internal fixation.The preoperative preparationtime,incision length,operation time,incisioncomplications,hindfoot mobility,and AmericanSociety of Foot and Ankle Surgery(AOFAS)hindfoot function score were compared between two groups of patients;The X-ray and CT examinations were performed before operation,after operation,and at the last follow-up.The Bohler angle,Gissane angle,and calcaneal width were measured to evaluate fracture reduction.Results There was no significant difference in the preoperative general information between two groups of patients(P>0.05).All 58 patients were followed up after the operation.The followup time was 10-18 months,with an average of(14.30±1.45)months.The preoperative preparation time(2.24±1.33)d,incision length(1.53±0.97)cm in the arthroscopy group was better than the minimally invasive group(5.62±3.05)d,(4.52±2.03)cm;Incision complications(0%)in the arthroscopic group were lower than those in the minimally invasive group(10.34%),and the hindfoot mobility score(4.83±1.12)points was higher than that in the minimally invasive group(2.45±0.86)points.The differences were statistically significant(P<0.05).There was no significant difference in operation time,AOFAS ankle and hindfoot scores between two groups(P>0.05).According to imaging analysis,the Gissane angle,Bohler angle,and calcaneal width of two groups were improved after the operation,and the differences were statistically significant(P<0.05).Compared with postoperation,there was no change in Gissane angle,Bohler angle,and calcaneal width of two groups at the last follow-up,and the difference was not statistically significant(P>0.05).Conclusion The precise and minimally invasive treatment of Sanders Ⅱ&Ⅲ calcaneal fractures under arthroscope combined with auxiliary instruments can significantly shorten the hospital stay,optimize the operation process,and the reduction and fixation is precise and minimally invasive.Compared with the minimally invasive open reduction and fixation,it has the advantages of less intraoperative bleeding,shorter incision,smaller trauma,clearer articular surface,etc,and the clinical effect is more satisfactory.