【摘要】 目的 比较不同手术方式治疗SandersⅡ型、Ⅲ型跟骨骨折的临床疗效。方法 回顾性分析2019年1月至2021年4月阜阳市人民医院骨科收治的63例跟骨骨折患者临床资料，其中男57例，女6例，年龄（43.2±11.0）岁（18～76岁）。根据治疗方法分为3组：克氏针组，采用闭合复位克氏针固定；微创组，采用跗骨窦切口微创钢板内固定；常规组，采用常规L形切口解剖钢板内固定。比较3组患者术后跟骨后关节面移位距离、B?hler角、Gissane角、跟骨内翻角以及跟骨宽度，评价复位效果。比较3组患者手术时间、围手术期出血量、术后更换敷料次数、骨折愈合时间及并发症情况，采用美国足踝外科协会（AOFAS）踝-后足评分标准评价临床疗效。结果 3组患者术后B?hler角、Gissane角、跟骨内翻角、跟骨宽度、关节面移位距离均较术前明显改善（P<0.05）;3组患者术后B?hler角、Gissane角、跟骨内翻角、跟骨宽度均无差异（P>0.05），术后关节面移位距离存在差异（P<0.05），其中常规组和微创组均优于克氏针组（P<0.05），常规组与微创组间无差异（P>0.05）。克氏针组在手术时间、围手术期出血量和术后更换敷料次数方面均优于微创组和常规组（P<0.05）；克氏针组和微创组术后并发症均低于常规组（P<0.05），而两组之间无差异（P>0.05）；微创组在围手术期出血量、术后更换敷料次数和并发症发生方面优于常规组（P<0.05），而两组手术时间比较无差异（P>0.05）。3组患者骨折愈合时间、末次随访AOFAS评分比较均无差异（P>0.05）。结论 3种手术方法均是治疗SandersⅡ型、Ⅲ型跟骨骨折的有效方法。与克氏针固定和常规L形入路内固定相比，经跗骨窦切口入路内固定既能获得良好的关节面复位，又能减少创伤和并发症发生，值得推荐。更多还原

【Abstract】 Objective To compare the clinical efficacy of different surgical approaches for treating Sanders type Ⅱ and type Ⅲ calcaneal fractures. Methods A retrospective analysis was conducted using the clinical data of 63 patients with calcaneal fractures who were admitted to the Department of Orthopedics of Fuyang People’s Hospital from January 2019 to April 2021. The patients included 57 men and 6 women, with a mean age of(43.2±11.0) years(range: 18 to 76 years). According to the treatment methods, the patients were assigned to three groups: Kirschner wire group(closed reduction internal fixation with Kirschner wire), minimally invasive group(internal fixation through tarsal sinus incision with a minimally invasive plate), and conventional group(internal fixation through conventional L-shaped incision with an anatomical plate). The following parameters were compared among the three groups to evaluate the reduction effect: the postoperative distance of the posterior articular surface displacement, B?hler angle, Gissane angle, calcaneal varus angle, and calcaneal width. The operative time, perioperative bleeding, wound dressing change time postoperatively, fracture healing time, and complication rate were also compared. Clinical outcomes were evaluated using the ankle hindfoot scoring standard of the American Association of Foot and Ankle Surgery(AOFAS). Results The B?hler angle, Gissane angle, calcaneal varus angle, calcaneal width, and the articular surface displacement of the three groups showed significant improvements postoperatively as compared to their preoperative values(P<0.05). The three groups showed no significant differences in the postoperative B?hler angle, Gissane angle, calcaneal varus angle, and calcaneal width(P>0.05). However, a significant difference was noted in the articular surface displacement postoperatively(P<0.05),with both the conventional and minimally invasive groups showing superior results to those of the Kirschner wire group(P<0.05), with no significant difference between the conventional and minimally invasive groups(P>0.05). Regarding the operative time, perioperative bleeding, and wound dressing change times, the Kirschner wire group was superior to the minimally invasive and conventional groups(P<0.05). To the complications incidence, the Kirschner wire group and minimally invasive group were all lower than the convention group(P<0.05), with no signficant difference between the Kirschner wire group and minimally invasive group(P>0.05). The minimally invasive group was superior to the conventional group in terms of perioperative bleeding and wound dressing change times(P<0.05), while the difference in the operative time between these two groups was not significant(P>0.05). Moreover, no significant differences in the fracture healing time and AOFAS scores at the last follow-up was noted among the three groups(P>0.05). Conclusion All three surgical methods are effective in treating Sanders type Ⅱ and type Ⅲ calcaneal fractures.Compared to the conventional L-shaped internal fixation and the Kirschner wire fixation, internal fixation through the tarsal sinus incision can achieve good articular surface reduction, reduce trauma, and decrease the incidence of complications, and it is therefore worth recommending.更多还原