跟骨骨折术中保留腓骨肌腱鞘完整对后足活动的影响

Effect of peroneal tendon sheath integrity on posterior foot movement during calcaneal fracture

目的在跟骨骨折病人中采用保留腓骨肌腱鞘完整的手术方法进行治疗,并与传统动态牵开腓骨肌腱的手术方式进行比较,分析其术后对后足活动的影响。方法2016年12月~2020年12月我院骨科收治的跟骨骨折病人60例,根据手术方法分为两组,牵开组28例,接受传统动态牵开腓骨肌腱的手术治疗;保留组32例,接受保留腓骨肌腱鞘完整的手术治疗。观察指标包括围手术期指标,术后12个月足功能Maryland评分,后足AOFAS评分及术后12个月影像学指标(Boler角、Gissane角)。结果保留组手术时间为(89.34±12.21)分钟,住院时间为(5.26±1.47)天,均明显优于牵开组[分别为(124.22±11.56)分钟,(11.59±2.43)天],差异有统计学意义(P<0.05)。所有病人均获随访,术后12个月随访时,保留组AOFAS评分为(70.56±3.62)分,Maryland优良率为87.5%,优于牵开组[分别为(81.37±3.58)分,71.4%],差异有统计学意义(P<0.05)。两组影像学指标间比较差异无统计学意义(P>0.05)。结论保留腓骨肌腱鞘完整的手术方法治疗跟骨骨折有确切的临床效果,还可降低创伤对后足活动的不良影响。

Objective In the patients with calcaneal fractures,the surgical method with intact peroneal tendon sheath was used to treat them,and compared with the traditional surgical method with dynamic retraction of the peroneal tendon,to analyze the influence of the surgical method on the posterior foot movement.Methods A retrospective analysis was made on 60 patients with calcaneal fracture admitted to the Department of Orthopaedics of our hospital from December 2016 to December 2020.The patients were divided into two groups according to the surgical method.The patients in the distraction group received the surgical treatment of traditional dynamic distraction of peroneal tendon(28 cases),and the patients in the preservation group received the surgical treatment of preserving the integrity of peroneal tendon sheath(32 cases).The outcome measures included perioperative indicators,Maryland score of foot function 12 months after surgery,AOFAS score of posterior foot and imaging indicators(Boler Angle and Gissane Angle)12 months after surgery.Results The surgical time(89.34±12.21 minutes)and hospitalization time(5.26±1.47 days)of the retention group were significantly better than those of the traction group[(124.22±11.56)min,(11.59±2.43)d](P<0.05).At the last follow⁃up,the AOFAS score(70.56±3.62)and Maryland’s excellent and good rate(87.5%)of patients in the retention group were better than those in the traction group(81.37±3.58,71.4%)(P<0.05).The difference in imaging indicators between the two groups was relatively small(P>0.05).Conclusion The surgical method of keeping the peroneal tendon sheath intact in the treatment of patients with calcaneal fracture has definite clinical effects,and can also effectively reduce the adverse effects of surgical trauma on posterior foot activity.