跗骨窦“八”字形切口入路钢板内固定手术治疗SandersⅡ、Ⅲ型跟骨骨折的效果

Effect of Sanders type Ⅱ to Ⅲ calcaneal fracture treated by internal fixation of steel plate through Chinese character "八" shaped incision of tarsal sinus approach

  • 摘要: 目的 探讨跗骨窦“八”字形切口入路钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折的临床效果。 方法 回顾性分析接受内固定手术治疗的82例跟骨骨折患者的临床资料,骨折Sanders分型为Ⅱ、Ⅲ型,均保留完整的临床手术资料和术后至少12个月的随访资料。根据手术入路方法的不同将患者分为微创组(n=37)和常规组(n=45), 微创组接受跗骨窦“八”字切口入路钢板内固定治疗,常规组接受经典外侧“L”形切口复位钢板内固定治疗,比较2组手术相关指标、并发症和术后12个月踝关节功能恢复等情况。 结果 2组手术时间、住院时间比较,差异无统计学意义(P>0.05); 微创组手术出血量(37.82±10.04)mL少于常规组的(62.29±13.20)mL, 切口并发症发生率10.81%低于常规组的31.11%, 差异均有统计学意义(P<0.05); 术后12个月随访资料显示, 2组患者均未发生内固定失败、骨折不愈合或畸形愈合等严重并发症; 2组间术后12个月跟骨Bohler角、Gissane角、Maryland足部功能评分和骨折愈合时间比较,差异均无统计学意义(P>0.05)。 结论 与外侧“L”形切口入路复位钢板内固定术相比,跗骨窦“八”字形切口入路钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折能减少手术出血量,降低切口并发症发生率,而2种术式的骨折愈合和足部功能恢复效果均较好。

     

    Abstract: Objective To investigate the clinical effect of Sanders type Ⅱ or Ⅲ calcaneal fracture treated by internal fixation of steel plate through Chinese character "八" shaped incision of tarsal sinus approach. Methods The clinical data of 82 patients with Sanders Ⅱ or Ⅲ type calcaneal fractures who were treated by internal fixation was retrospectively analyzed. All patients retained complete clinical operation data and follow-up data at least 12 months after operation. According to different surgical approaches, the patients were divided into minimally invasive group(n=37)and conventional group(n=45). The minimally invasive group received internal fixation of steel plate through Chinese character "八" shaped incision of tarsal sinus approach, and the conventional group received classical open reduction with lateral L-shaped incision approach and plate internal fixation. The operation related indicators, complications and ankle function recovery at 12 months after operation were compared. Results There were no significant differences in operation time and hospitalization time between the two groups(P>0.05). the amount of bleeding in the minimally invasive group was(37.82±10.04)mL, which was less than(62.29±13.20)mL in the conventional group, and the rate of incision-related complications was 10.81%, which was lower than 31.11% in the conventional group, the differences were statistically significant(P<0.05); The follow-up results of 12 months after operation showed that there were no serious complications such as internal fixation failure, fracture nonunion or malunion. There were no significant differences in Bohler's angle as well as Gissane's - angle of calcaneus at 12 months after operation, fracture healing time and Maryland foot function score between the groups(P>0.05). Conclusion Compared with traditional open reduction with lateral L-shaped incision approach and internal fixation, internal fixation of steel plate through Chinese character "八" shaped incision of tarsal sinus approach can reduce the amount of bleeding and incidence of incision-related complications for Sanders Ⅱ or Ⅲ type calcaneus fracture. The two methods have better efficacy in fracture healing and foot function recovery.

     

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