谭兴春,程亮
TAN Xingchun,CHENG Liang

• 1:开州区人民医院骨科

摘要(Abstract)：

目的:探讨经跗骨窦有限切开内固定与外侧L形切口内固定治疗Sanders Ⅲ型跟骨骨折的效果。方法:选取SandersⅢ型跟骨骨折患者66例随机分为对照组和观察组,对照组行外侧L形切口复位内固定术式,观察组行经跗骨窦有限切开复位内固定术式;比较两组切口长度、手术时间、术中出血量、住院时间、骨折愈合时间,VAS量表评估疼痛程度,X线片检查测量Gissane、Bohler角和距下关节面移位,AOFAS量表进行疗效评价,同时比较并发症发生率。结果:观察组手术切口长度、手术时间、术中出血量,以及住院时间均优于对照组(P<0.01),但两组骨折愈合时间差异无统计学意义(P>0.05);术后Gissane角、Bohler角大于术前(P<0.01),距下关节移位均小于术前(P<0.01),但两组间比较差异无统计学意义(P>0.05);两组术后VAS评分均较术前降低(P<0.01),且观察组低于对照组(P<0.01);两组术后AOFAS评分较术前显著提高(P<0.01),但两组AOFAS评分以及评分优良率差异无统计学意义(P>0.05);两组术后并发症发生率比较差异无统计学意义(χ~2=0.733,P>0.05)。结论 :经跗骨窦有限切开内固定术式治疗Sanders Ⅲ型跟骨骨折具有手术切口小、手术时间短、术中出血少、术后疼痛较轻、住院时间短等优点。
Objective: To compare the clinical effect of internal fixation by sinus tarsi approach with traditional lateral L-type approach for treatment of Sanders type Ⅲ calcaneal fractures. Methods: Sixty-six Sanders Ⅲ calcaneal fractures patients were randomly assigned into control group( n = 33) and observation group( n = 33). Patients in control group were treated with traditional lateral L-type approach,while patients in observation group underwent internal fixation by sinus tarsi approach. The length of incision,operation time,blood loss,length of stay,and fracture healing time of the 2 groups were compared. One year after following up,the degree of pain was evaluated by VAS scale. The Gissane angle,Bohler angle and displacement of lower joint were detected by X-ray. The recovery of fractures was evaluated by ankle hind foot scoring system( AOFAS). Results: The length of incision,operation time,blood loss and length of stay in the observation group were better than those in control group( P < 0. 01). The fracture healing time of two groups was not significantly different( P > 0. 05).The Gissane angle,Bohler angle and displacement of lower joint of two groups after operation were both better before( P < 0. 01),and there was no significant difference between the two groups( P > 0. 05).The postoperative VAS scores of two groups were decreased,and it was lower in observation group than in control group( P < 0. 01). The postoperative AOFAS scores of the two groups were significantly improved compared with that before operation( P < 0. 01),but there was no significant difference between the two groups( P > 0. 05). There was no significant difference in the incidence of postoperative complications between the two groups( χ~2= 0. 733,P > 0. 05). Conclusion: Internal fixation by sinus tarsi approach has the advantages of alleviating surgical injury,shortening operation time,reducing blood lose,postoperative pain,and length of stay.

关键词(KeyWords)： 跟骨;骨折;骨折固定术,内;骨折愈合;疼痛,手术后
calcaneus;fracture;fracture fixation,internal;fracture healing;pain,postoperation

Abstract:

Keywords:

基金项目(Foundation): 重庆市卫生科技计划项目(20110418)

作者(Author): 谭兴春,程亮
TAN Xingchun,CHENG Liang

DOI: 10.19367/j.cnki.1000-2707.2017.01.026

参考文献(References)：

• [1]de Vroome SW,van der Linden FM.Cohort study on the percutaneous treatment of displaced intra-articular fractures of the calcaneus[J].Foot Ankle Int,2014(2):156-162.
• [2]刘德淮,黄晖,庄小强.两种不同方法治疗SandersⅢ型跟骨关节内骨折的疗效对比[J].中国矫形外科杂志,2015(6):496-501.
• [3]戴鹏,孙劲,黄晖,等.SandersⅡ型跟骨骨折不同入路切开复位内固定疗效及对距下关节活动度的影响[J].中国骨与关节外科,2014(4):285-288.
• [4]伍凯,林健,黄建华,等.经跗骨窦切口与经外侧“L”型切口治疗SandersⅢ型骨折的疗效比较[J].中华骨科杂志,2015(8):825-832.
• [5]徐浩,蒋元斌,刘耀辉.传统外侧“L”形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药,2015(1):86-88.
• [6]魏世隽,蔡贤华,刘曦明,等.经跗骨窦小切口微型锁定接骨板组合经皮螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华创伤骨科杂志,2013(12):1037-1040.
• [7]赵雅宁,郝正玮,李建民.下肢康复训练机器人对缺血性脑卒中偏瘫患者平衡及步行功能的影响[J].中国康复医学杂志,2012(11):1015-1020.
• [8]Kissel CG,Husain ZS,Cottom JM.Early clinical and radiographic outcomes after treatment of displaced intra-articular calcaneal fractures using delta-frame external fixator construct[J].J Foot Ankle Surg,2011(2):135-140.
• [9]施忠民,邹剑,顾文奇,等.经跗骨窦间隙与外侧“L”形切口治疗SandersⅡ型跟骨骨折的疗效比较[J].中华骨科杂志,2013(4):298-303.
• [10]徐建民,于超.改良外侧L型切口与传统L型切口治疗跟骨骨折的比较研究[J].中国矫形外科杂志,2013(22):2313-2316.
• [11]伍凯,林健,黄建华.扩大L型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析[J].上海交通大学学报:医学版,2014(7):1043-1048.
• [12]郝东升,陈晨,王东,等.跟骨骨折外侧延长L形切口并发症非手术相关危险因素分析[J].中国修复重建外科杂志,2013(1):30-35.
• [13]Xia S,Lu Y,Wang H,et al.Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures-a randomized controlled trial[J].Int J Surg,2014(5):475-480.
• [14]李伯州,胡牧,徐向阳.跗骨窦入路治疗SandersⅢ型跟骨关节内骨折[J].中华创伤骨科杂志,2014(12):1043-1048.
• [15]林烨澎,何志明,汪志中.跗骨窦小切口与传统外侧L型切口内固定治疗跟骨骨折的对比研究[J].中国骨科临床与基础研究杂志,2016(3):152-157.
• [16]黄建华,伍凯,林健.F3微型锁定接骨板治疗跟骨SandersⅡ、Ⅲ型骨折[J].华南国防医学杂志,2015(3):181-184.
• [17]Howard JL,Buckley R,Mc Cormack R.Complications following management of displaced intra-articular calcaneal fractures:a prospective randomized trial comparing open reduction internal fixation with nonoperative management[J].J Orthop Trauma,2003(4):241-249.

文章评论(Comment)：