关节镜辅助下微创钉中钉内固定治疗跟骨骨折的临床疗效

Clinical efficacy of arthroscopically assisted minimally invasive nail-in-nail internal fixation in the treatment of calcaneal fractures

目的 探讨关节镜辅助下微创钉中钉内固定治疗跟骨骨折的临床效果。方法 回顾性分析了2019年10月至2022年12月淄博市中医医院收治的16例跟骨骨折患者临床资料。其中,男10例,女6例;年龄32~68岁,平均年龄(44.63±10.10)岁。所有患者均接受关节镜辅助下微创钉中钉内固定治疗方式。记录患者的手术时间、术中出血量、住院时间,观察骨折愈合时间,比较患者术前术后跟骨长度、高度、宽度,以及B?hler角、Gissane角的恢复情况,应用AOFAS标准评定对末次随访时足部功能进行评定。结果 术后随访6~18个月,平均(10.21±3.47)个月。16例患者全部成功实施手术,无切口感染、皮肤坏死等并发症发生。患者的手术时间为(105.63±10.47)min,术中出血量为(21.25±7.42)mL,住院时间为(7.13±1.26)d。患者全部实现骨性愈合,愈合时间为3~7个月,平均(5.06±1.34)个月。末次随访时跟骨的长度、高度、宽度、B?hler角、Gissane角均较术前明显改善,差异有统计学意义(P<0.05)。与术前比较,末次随访时美国矫形足踝协会足功能AOFAS标准评定为85~97分,平均(91.25±3.77)分,功能显著改善。结论 关节镜辅助下微创钉中钉内固定治疗跟骨骨折是一种有效的治疗方法,具有操作微创、机体损伤较小、减少了相关手术并发症发生率、术后恢复快的优点,为临床微创治疗跟骨骨折提供了一种选择。

Objective To explore the clinical effect of arthroscopically assisted minimally invasive nail-in-nail internal fixation in the treatment of calcaneal fractures.Methods A retrospective analysis was conducted on the clinical data of 16 patients with calcaneal fractures admitted to Zibo Hospital of Traditional Chinese Medicine from October 2019 to December 2022.Among them,there are 10 males and 6 females;aged from 32 to 68 years old,with an average age of(44.63±10.10)years.All patients underwent arthroscopically assisted minimally invasive nail-in-nail internal fixation treatment.The operation time,intraoperative blood loss,length of hospital stay and fracture healing time were recorded.The calcaneal length,height,width,as well as the recovery of Böhler and Gissane angles before and after surgery,and foot function at the last follow-up using the American Orthopedic Association of Foot and Ankle(AOFAS)standards were evaluated.Results The postoperative follow-up period was 6-18 months,with an average of(10.21±3.47)months.All 16 patients successfully underwent surgery without complications such as incision infection or skin necrosis.The operation time was(105.63±10.47)min,the intraoperative blood loss was(21.25±7.42)mL,and the hospital stay was(7.13±1.26)d.All patients achieved bone healing,with a healing time of 3-7 months and an average of(5.06±1.34)months.At the last follow-up after surgery,the length,height,width,Böhler angle,and Gissane angle of the calcaneus were significantly improved compared to before surgery,and the differences were statistically significant(P<0.05).Compared with the preoperative assessment,at the last follow-up,the AOFAS rated foot function as 85-97 points,with an average of(91.25±3.77)points,indicating a significant improvement in function.Conclusion Arthroscopic assisted minimally invasive nail-in-nail internal fixation is an effective treatment method for calcaneal fractures,which has the advantages of minimally invasive operation,minimal body damage,reduced incidence of related surgical complications,and fast postoperative recovery.It represents an option for clinical minimally invasive treatment of calcaneal fractures.