【摘要】 目的:对比分析探讨经跗骨窦切口与外侧L形切口手术治疗跟骨骨折的早期临床疗效。方法:回顾性分析我科近2年来经采取跗骨窦切口手术治疗的22例(22足,Sanders分型为Ⅱ型或Ⅲ型)跟骨骨折病人,同时选取了我科曾经采用外侧L形切口手术治疗的22例(23足,Sanders分型为Ⅱ型或Ⅲ型)跟骨骨折病人。对比分析两组患者术前、术后跟骨长度、宽度、高度、跟骨Bohler角及Gissane角,比较两组患者手术时间、术中出血量及术前、术后住院时间。结果:跗骨窦切口与外侧L形切口两者术前跟骨高度、长度、宽度、 Bohler角及Gissane角等方面比较均无统计学差异,两者具有可比性,术后两者跟骨高度、长度、宽度、Bohler角及Gissane角比较也无统计学差异,但两者术前与术后跟骨高度、长度、宽度、Bohler角及Gissane角比较有显著统计学差异(P<0.05),术后跟骨高度、长度、宽度、Bohler角及Gissane角均达到了正常范围。两组患者在手术时间、术中出血量及术前、术后住院时间比较均有统计学差异(P<0.05)。跗骨窦切口手术时间短,术中出血量少,而且术前及术后住院时间也短。早期软组织并发症发生率两者比较也有统计学差异(P<0.05),跗骨窦切口软组织并发症明显降低。术后1年VAS评分两者在0～3分之间,AOFAS踝-后足评分两者在73～100分之间。跗骨窦切口优3例,良8例,优良率92%。L形切口优1例,良10例,优良率85%。结论:跗骨窦切口手术治疗SandersⅡ型或Ⅲ型跟骨骨折不仅可取得与外侧L形切口相当的临床疗效,还具有创伤小、软组织并发症少等微创手术的优势,而且患者住院时间短,满意度高。更多还原

【Abstract】 Objective:A comparative analysis to explore the early clinical efficacy of surgical treatment of calcaneal fractures through sinus tarsi incision and lateral L-shaped incision. Method: We retrospectively analyze 22 cases(22 feet, Sanders classification is type Ⅱ or type Ⅲ) of calcaneal fracture patients treated with sinus tarsi incision surgery and 22 cases(23 feet, Sanders classification is type Ⅱ or type Ⅲ) of calcaneal fracture patients treated with lateral L-shaped incision surgery in our department in the past 2 years. We compare and analyze the calcaneal length, width, height, calcaneal Bohler angle, Gissane angle of the two groups of patients before and after the operation, and compare the operation time, intraoperative blood loss, and preoperative and postoperative hospital stay between the two groups. Results: sinus tarsi incision and lateral L-shaped incision have no statistical difference in calcaneal height, length, width, Bohler angle, Gissane angle before operation, and the two are comparable. There is also no statistical difference in calcaneal height, length, width, Bohler angle, Gissane angle of the two groups after operation. However, the preoperative and postoperative calcaneal height, length, width, Bohler angle, Gissane angle of the two groups are significantly different(P<0.05), and the postoperative calcaneal height, length, width, Bohler angle, Gissane angle of the calcaneus all reach the normal range. There are statistical differences between the two groups in operation time, intraoperative blood loss and hospitalization time before and after operation(P<0.05). The incision of the sinus tarsal has a short operation time, a small amount of intraoperative blood loss, and a short hospital stay before and after the operation. The incidence of early soft tissue complications is also statistically different between the two(P<0.05), and the soft tissue complications of the sinus tarsi incision are significantly reduced. One year after the operation, the VAS score is between 0-3 points. The AOFAS ankle-hindfoot score is between 73-100 points. Sinus tarsi incision was excellent in 3 cases, good in 8 cases, excellent and good rate was 92 %. L-shaped incision was excellent in 1 case, good in 10 cases, and the excellent and good rate was 85 %. Conclusion: Sinus tarsal incision surgery for the treatment of calcaneal fractures can not only achieve clinical results equivalent to that of lateral L-shaped incisions(except for some severe Sanders Ⅲ and Ⅳ comminuted fractures or combined with severe comminuted fractures of the calcaneal body), it also has advantages of minimally invasive surgery such as less trauma and fewer soft tissue complications, and short hospital stay and high satisfaction. Most calcaneal fractures in clinical practice can achieve satisfactory results with sinus tarsal surgery, and it is of great clinical value to promote and implement.更多还原