弧形改良切口与传统“L” 形切口治疗粉碎性跟骨骨折疗效比较

Comparison of the clinical effects of modified arc-shaped incision and traditional“L”-shaped incision in comminuted calcaneal fractures

目的:比较弧形改良切口和传统“L”形切口治疗粉碎性跟骨骨折的临床效果。方法:收集2020年1月~2022年10月在弋矶山医院手术的43例粉碎性跟骨骨折患者作为研究对象。23例采用弧形改良切口治疗(改良组),20例采用“L”形切口治疗(对照组)。根据影像学资料测量跟骨骨折手术前后Gissane角、Bohler角、宽度和高度数值,对两组手术前后组内、诅间各项影像学指标进行比较。将两组手术时间、切口缝合时间、术后并发症以及美国足与踝关节协会(AOFAS)评分进行比较。结果:两组患者随访时间为10~16个月,中位随访时间12.62个月。两组患者术后跟骨宽度、高度、Gissane角及Bohler角均较术前改善(P<0.001),但改良组患者术前、术后各项影像学指标变化幅度与对照组相比差异均无统计学意义(P>0.05)。两组患者手术时间和切口缝合时间方面差异均无统计学意义(P>0.05)。改良组术后并发症发生率(0.0%)低于对照组(30.0%),P<0.05。改良组患者AOFAS评分(87.56±4.73)优于对照组(73.95±4.38),P<0.001。结论:弧形改良切口治疗粉碎性跟骨骨折具有切口并发症少、疗效显著的优点,值得推广。

Objective:To compare the clinical efficacy of modified curved incision and traditional L-shaped incision in the treatment of comminuted calcaneal fractures.Methods:Forty-three cases of comminuted calcaneal fractures treated in our hospital were included from January 2020 to October 2022,and divided into modified group(treated with modified arc-shaped incision,n=23)and control group(treated with traditional L-shaped incision,n=20).The data were compared pertaining to imaging findings for the Gissane angle and B hler angle,width and height values measured before and after surgery as well as the imaging indexes within group and between groups.In addition,the two groups were also compared regarding the operative time,the time to suture incision,postoperative complications,and scores by American Orthopedic Foot and Ankle Society(AOFAS).Results:Patients in both groups were followed for 10 to 16 months,with a median follow-up time of 12.62 months.The calcaneal width,height,Gissane angle and B hler angle of the two groups of patients were significantly improved after surgery(P<0.001),yet the changes were insignificant between groups before and after surgery(P>0.05).There was no significant difference in the operative time and the time to suture incision between the two groups(P>0.05),whereas the incidence of postoperative complication was lower,and the AOFAS scores were better in the modified group compared to control group(0.0%vs.30.0%,P<0.05;87.56±4.73 vs.73.95±4.38,P<0.001).Conclusion:The modified arc-shaped incision is worthy of wider recommendation because of its fewer incisional complications and significant curative effect in the treatment of comminuted calcaneal fractures.