改良跗骨窦切口和扩大跟骨外侧L形切口钢板固定治疗SanderⅡ~Ⅲ型跟骨骨折术后疗效和并发症比较

Comparison of postoperative efficacy and complications between modified tarsal sinus incision and expanded lateral calcaneal L-shaped incision plate fixation for SanderⅡ-Ⅲcalcaneal fractures

目的:比较改良跗骨窦切口和扩大跟骨外侧L形切口钢板固定治疗SanderⅡ~Ⅲ型跟骨骨折术后疗效和并发症发生情况。方法:选取80例SanderⅡ~Ⅲ型跟骨骨折病人,随机分为跗骨窦切口组和L形切口组,各40例,分别行改良跗骨窦切口、扩大跟骨外侧L形切口钢板固定治疗。比较2组手术情况、恢复情况、术后并发症发生情况及术后12个月足踝关节功能变化。结果:跗骨窦切口组手术时间、术中出血量、术后住院时间均明显低于L形切口组(P<0.01),2组骨折愈合时间差异无统计学意义(P>0.05)。跗骨窦切口组术后并发症发生率为5.00%(2/40),低于L形切口组的22.50%(9/40)(P<0.05)。2组术后1年Bohler角、Gissane角、跟骨中部宽度、Mayfand评分均高于术前(P<0.05);跗骨窦切口组术后1年Mayfand评分明显高于L形切口组(P<0.01)。跗骨窦切口组术后1年临床优良率为77.50%(31/40),高于L形切口组的60.00%(24/40)(P<0.05)。结论:改良跗骨窦切口治疗Sander SanderⅡ~Ⅲ型跟骨骨折的疗效优于扩大跟骨外侧L形切口钢板固定,且前者术后恢复更快、并发症发生率更低、足部功能恢复更理想。

Objective:To compare the efficacy and complications of modified tarsal sinus incision and expanded lateral calcaneal L-shaped incision plate fixation for SanderⅡ-Ⅲcalcaneal fractures.Methods:Eighty patients with SanderⅡ-Ⅲcalcaneal fractures were selected and randomly divided into the tarsal sinus incision group and L-shaped incision group,with 40 cases in each group,and the patients were treated with modified tarsal sinus incision and expanded L-shaped incision plate fixation,respectively.The operation situation,recovery situation,postoperative complications and changes of ankle function at 12 months after operation were compared between the two groups.Results:The operation time,intraoperative bleeding and postoperative hospital stay in the tarsal sinus incision group were significantly lower than those in the L-shaped incision group(P<0.01),and there was no significant difference in fracture healing time between the two groups(P>0.05).The incidence of postoperative complications in the tarsal sinus incision group was 5.00%(2/40),which was lower than that of 22.50%(9/40)in the L-shaped incision group(P<0.05).The Bohler angle,Gissane angle,middle calcaneal width and Mayfand score in the two groups were higher than those before operation(P<0.05).The Mayfand score at one year after operation in the tarsal sinus incision group was significantly higher than that in the L-shaped incision group(P<0.01).The excellent and good rate at one year after operation in the tarsal sinus incision group was 77.50%(31/40),which was higher than that of 60.00%(24/60)in the L-shaped incision group(P<0.05).Conclusions:The curative effect of modified tarsal sinus incision for SanderⅡ-Ⅲcalcaneal fractures is better than that of expanded lateral calcaneal L-shaped incision plate fixation,and the former has faster postoperative recovery,lower incidence of complications and better recovery of foot function.