【摘要】 目的:探讨跗骨窦入路切开复位微创解剖接骨板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效与安全性。方法:回顾性分析54例SandersⅡ、Ⅲ型跟骨骨折患者的病例资料,其中采用跗骨窦入路切开复位微创解剖接骨板内固定治疗26例(跗骨窦入路组),采用外侧扩大的L形入路切开复位解剖锁定接骨板内固定治疗28例(外侧扩大的L形入路组)。比较2组患者骨折至手术时间、手术时间、术中出血量、术后引流量、跟骨高度和宽度、B9hler角、Gissane角、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分及并发症发生情况。结果:跗骨窦入路组的骨折至手术时间、手术时间、术中出血量及术后48 h引流量均少于外侧扩大的L形入路组[(4.9±1.8)d,(9.4±2.3)d,t=11.240,P=0.009;(49.5±10.1)min,(74.7±15.4)min,t=7.870,P=0.013;(64.4±21.0)mL,(115.4±24.6)mL,t=7.450,P=0.038;(34.7±17.6)mL,(60.4±19.7)mL,t=6.540,P=0.042]。术后12个月,2组患者的跟骨高度、跟骨宽度、B9hler角、Gissane角、AOFAS踝与后足功能评分比较,组间差异均无统计学意义[(41.7±2.1)mm,(40.2±2.0)mm,t=1.478,P=0.450;(31.7±2.4)mm,(32.4±2.2)mm,t=0.179,P=0.180;31.2°±2.7°,29.6°±2.2°,t=2.710,P=0.680;131.4°±2.1°,134.3°±2.4°,t=0.778,P=0.790;(91.8±5.4)分,(90.1±4.9)分,t=0.220,P=0.750]。跗骨窦入路组1例出现腓肠神经损伤症状,经口服营养神经药物治疗后缓解,均未出现切口感染、皮缘坏死及延迟愈合等并发症;外侧扩大的L形入路组3例出现切口感染、皮缘坏死,其中2例经换药后切口愈合,1例出现跟骨接骨板外露,给予局部皮瓣覆盖后愈合良好。2组患者的并发症发生率比较,差异无统计学意义(χ~2=0.927,P=0.336)。结论:采用跗骨窦入路切开复位微创解剖接骨板内固定和外侧扩大的L形入路切开复位解剖锁定接骨板内固定治疗SandersⅡ、Ⅲ型跟骨骨折临床疗效、安全性相当,但前者术前准备时间短、手术创伤小、手术时间短。更多还原

【Abstract】 Objective:To explore the clinical curative effects and safety of open reduction and minimally invasive anatomic bone plate internal fixation through sinus tarsal approach for treatment of Sanders typeⅡandⅢcalcaneus fractures.Methods:The medical records of 54 patients with Sanders typeⅡandⅢcalcaneus fractures were analyzed retrospectively.Twenty-six patients were treated with open reduction and minimally invasive anatomic bone plate internal fixation through sinus tarsal approach(group A),while the others were treated with open reduction and anatomic locking bone plate internal fixation through extended lateral L-shaped approach(group B).The duration from fracture to surgery,operative time,intraoperative blood loss,postoperative drainage volume,calcaneus height,calcaneus width,B9 hler angle,Gissane angle,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores and complication incidence were compared between the 2 groups.Results:The duration from fracture to surgery and operative time were shorter and the intraoperative blood loss and postoperative 48-hour drainage volume were less in group A compared to group B(4.9+/-1.8 vs 9.4+/-2.3 days,t=11.240,P=0.009;49.5+/-10.1 vs 74.7+/-15.4 minutes,t=7.870,P=0.013;64.4+/-21.0 vs 115.4+/-24.6 mL,t=7.450,P=0.038;34.7+/-17.6 vs 60.4+/-19.7 mL,t=6.540,P=0.042).There was no statistical difference in calcaneus height,calcaneus width,B9 hler angle,Gissane angle and AOFAS ankle-hindfoot function scores between the 2 groups at 12 months after the surgery(41.7+/-2.1 vs 40.2+/-2.0 mm,t=1.478,P=0.450;31.7+/-2.4 vs 32.4+/-2.2 mm,t=0.179,P=0.180;31.2+/-2.7 vs 29.6+/-2.2 degrees,t=2.710,P=0.680;131.4+/-2.1 vs 134.3+/-2.4 degrees,t=0.778,P=0.790;91.8+/-5.4 vs 90.1+/-4.9 points,t=0.220,P=0.750).Sural nerve injuries were found in 1 patient and the symptoms relieved after oral application of neurotrophic drugs,and no complications such as incision infection,cutaneous margin necrosis and delayed healing were found in group A. Incision infection and cutaneous margin necrosis were found in 3 patients in group B,and the incisions healed in 2 patients after dressing change and in 1 patient with calcaneal bone plate exposure after treatment with local skin flap transplantation. There was no statistical difference in complication incidences between the 2 groups( χ2= 0. 927,P = 0. 336). Conclusion: Open reduction and minimally invasive anatomic bone plate internal fixation through sinus tarsal approach is similar to open reduction and anatomic locking bone plate internal fixation through extended lateral L-shaped approach in the clinical curative effects and safety in treatment of Sanders typeⅡandⅢcalcaneus fractures,however,the former has the advantages of shorter preoperative preparation time and operative time and less operative injury.更多还原