跗骨窦切口微创锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析

Minimally invasive fixation with a locking plate for SandersⅡandⅢcalcaneal fractures via the tarsal sinus approach

目的探讨跗骨窦切口微创锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法回顾性分析2019年4月至2020年9月滨州医学院附属医院足踝外科收治的65例SandersⅡ、Ⅲ型跟骨骨折患者资料。其中男44例,女21例;年龄(42.5±10.4)岁;骨折Sanders分型:Ⅱ型46例,Ⅲ型19例。根据手术方式不同分为S组(经跗骨窦切口微创锁定接骨板固定,35例)和L组(经L形切口锁定接骨板固定,30例)。比较两组患者的术前等待时间、手术时间、住院时间、术中出血量、术后3 d的疼痛视觉模拟评分(VAS)、术后1年的美国足踝外科协会(AOFAS)的踝-后足评分、Maryland足功能评分优良率、B?hler角、Gissane角、内翻角,并观察并发症的发生情况。结果两组患者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。所有患者术后随访(13.3±1.6)个月。S组的术前等待时间[(2.8±1.8)d]、手术时间[(80.7±9.9)min]、住院时间[(6.7±1.9)d]、术中出血量[(54.3±14.2)mL]、术后3 d VAS评分[6(5,7)分]均显著少于L组[(8.2±2.8)d、(105.0±15.7)min、(14.6±3.4)d、(74.3±12.8)mL、7(6,8)分],差异均有统计学意义(P<0.05)。术后1年S组患者的AOFAS的踝-后足评分[(90.1±3.5)分]显著高于L组[(83.5±6.7)分],差异有统计学意义(P<0.05)。术后1年两组Maryland足功能评分优良率[91.4%(32/35)vs.86.7%(26/30)]比较差异无统计学意义(P=0.695)。所有患者术后1年的B?hler角、Gissane角、内翻角均较术前显著改善,差异均有统计学意义(P<0.05);但术后3 d、1年的组内和两组间比较差异均无统计学意义(P>0.05)。S组中1例出现腓骨肌疼痛;L组中2例皮肤坏死,1例切口内血肿,1例腓肠神经损伤。结论跗骨窦切口微创锁定接骨板治疗SandersⅡ、Ⅲ型跟骨骨折,疗效满意。

Objective To evaluate the minimally invasive fixation with a locking plate via the tarsal sinus approach in the surgical treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.MethodssAretrospective study was conducted to analyze the 65 patients who had been surgically treated for Sanders Ⅱ and Ⅲ calcaneal fractures at Department of Foot and Ankle Surgery,Binzhou Medical College Hospital from April,2019 to September,2020.There are 44 males and 21 females with an age of(42.5±10.4)years,and 46 Sanders typeⅡfractures and 19 Sanders type Ⅲ ones.The patients were divided into group L and group S according to surgical methods.Group S of 35 cases was fixated with a minimally invasive locking plate through the tarsal sinus incision while group L of 30 cases fixated with a locking plate through the L-shaped incision.The 2 groups were compared in terms of waiting time before surgery,surgical time,hospital stay,intraoperative bleeding,visual analogue scale(VAS)at 3 days after surgery,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score at 1 year after surgery,excellent and good rate by the Maryland foot function score,Bohler angle,Gissane angle,varus angle,and complications.Results There was no significant difference in the general data before surgery between the 2 groups,showing comparability(P>0.05).All patients were fllowed up for(13.3±1.6)months after surgery.The waiting time before surgery[(2.8±1.8)d],surgical time[(80.7±9.9)min],hospital stay[(6.7±1.9)d],intraoperative bleeding[(54.3±14.2)mL],and VAS at 3 days afer surgery[6(5,7) points]in group S were all significantly less or lower than those in group L[(8.2±2.8)d,(105.0±15.7)min,(14.6±3.4)d,(74.3±12.8)mL,and 7(6,8)points](all P<0.05).At one year after surgery,the AOFAS ankle-hindfoot score[(90.1±3.5)points]in group S was significantly higher than that in group L[(83.5±6.7)points](P<0.05),but there was no statistically significant difference in the excellent and good rate by the Maryland foot function score between the 2 groups[91.4%(32/35)versus 86.7%(26/30)](P=0.695).The Bohler angle,Gissane angle,and varus angle were significantly improved in all patients one year after surgery compared with the values before surgery(P<0.05),but there were no statistically significant differences within either group or between the 2 groups at 3 days or 1 year after surgery(P>0.05).Peroneal muscle pain was reported in 1 case in group S;there were 2 cases of skin necrosis,1 case of incision hematoma and 1 case of sural nerve injury in group L.Conclusion Theminimally invasive fixation with a locking plate via the tarsal sinus approach is an effective treatment for Sanders Ⅱ and Ⅲ calcaneal fractures.