【作者】 周健；

【导师】 张胜利；

【作者基本信息】 安徽医科大学 ， 外科学（骨科）， 2021， 硕士

【摘要】 背景:跟骨是足部跗骨最大的一块,其在高处坠落伤中极易发生骨折,占跗骨损伤的60%。目前跟骨骨折最常用的手术入路为外侧L型入路。此入路充分切开跟骨表面皮肤及软组织,使骨折线及受累的关节面得以完整地暴露,进一步在直视下对跟骨解剖结构进行复位。直视下复位后通过钢板进行坚强固定,从而恢复跟骨的解剖形态,达到功能康复的目的。但外侧L型切口入路因为损伤大,并发症高发,所以改良跗骨窦切口逐渐用于临床。目的:通过对深圳市某三甲医院创伤骨科既往跟骨骨折患者进行随访及调查,了解该医院不同手术入路治疗跟骨骨折患者术后恢复情况,通过病例对照研究,通过对比STA与ELA两种手术入路对跟骨骨折患者住院时间、手术时间、切口长度、术后疼痛、并发症发生率等相关数据进行对比来探讨两种手术入路对跟骨骨折患者预后的影响。方法:取深圳市第二人民医院创伤骨科2018年9月至2020年9月之间收治的跟骨骨折患者病历进行回顾的同时,对患者本人进行随访。结果:跗骨窦切口组平均手术时间长于外侧L型切口组,其中,研究组平均手术时间为131.42min,对照组平均手术时间为86.13min。P<0.05。跗骨窦切口组术后引流量较外侧L型切口小,P<0.05。住院总时间研究组短于对照组,研究组平均住院总时间(12.64d±2.937d),对照组(15.00d±4.673d)P<0.05。术后留置引流时间差异无统计学意义。外侧L型切口组发生5例切口皮缘坏死,跗骨窦切口组无术后不良反应。结论:跗骨窦入路较外侧L型切口入路创伤小,可有效避免皮缘坏死和感染的发生,更有利于提高患者的临床疗效。更多还原

【Abstract】 Background: The calcaneus is the largest piece of the tarsal bone of the foot.It is easy to fracture in the fall injury,accounting for 60% of the tarsal bone injury.At present,the most commonly used surgical approach for calcaneal fracture is the extensile L shape approach.This approach fully incision the skin and soft tissue of the calcaneal surface,so that the fracture line and the affected articular surface can be completely exposed,and the anatomical structure of the calcaneus can be further reduced under direct vision.After direct reduction,the calcaneus was firmly fixed by steel plate,so as to restore the anatomical form of calcaneus and achieve the purpose of functional rehabilitation.However,the tarsal sinus approach is gradually used in clinic because of the large injury and high incidence of complications.Objective: Through follow-up and investigation of patients with past calcaneal fracture in trauma department of a third-class hospital in shenzhen city,to understand the postoperative recovery of patients with calcaneal fracture through different surgical approaches in this hospital,through a case-control study,The effects of STA and ELA surgical approaches on the prognosis of calcaneal fracture patients were compared.Methods: The medical records of calcaneal fracture patients treated in trauma orthopedics department of Shenzhen second people’s Hospital from September 2018 to September 2020 were reviewed and followed up.Results: The average operation time of the tarsal sinus approach group was longer than that of the extensile L shape approach group,in which the average operation time of the study group was 131.42 min,the average operation time of the control group was 86.13 min.P<0.05.The drainage volume of the tarsal sinus approach group was smaller than that of the extensile L shape approach,P<0.05.The total hospitalization time of the study group was shorter than that of the control group,the average total hospitalization time of the study group(12.64 d±2.937 d),the control group(15.00 d±4.673 d)P <0.05.There was no significant difference in drainage time after operation.Five cases of skin margin necrosis occurred in the extensile L shape approach group,and there was no postoperative adverse reaction in the tarsal sinus approach group.Conclusion: Compared with the extensile L shape approach,the tarsal sinus approach can effectively avoid the occurrence of skin margin necrosis and infection,and is more conducive to improving the clinical efficacy of patients.更多还原