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[1]徐啟飛,林巋然,趙廣輝.跗骨竇入路切開復(fù)位微創(chuàng)解剖接骨板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折的臨床研究[J].中醫(yī)正骨,2020,32(10):26-30.
　XU Qifei,LIN Kuiran,ZHAO Guanghui.A clinical study of open reduction and minimally invasive anatomic bone plate internal fixation through sinus tarsal approach for treatment of Sanders typeⅡandⅢcalcaneus fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(10):26-30.
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跗骨竇入路切開復(fù)位微創(chuàng)解剖接骨板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年10期
頁碼:
26-30
欄目:
臨床研究
出版日期:
2020-10-20

文章信息/Info

Title:
A clinical study of open reduction and minimally invasive anatomic bone plate internal fixation through sinus tarsal approach for treatment of Sanders typeⅡandⅢcalcaneus fractures
作者:
徐啟飛; 林巋然; 趙廣輝
(平頂山市第一人民醫(yī)院,河南 平頂山 467000)
Author(s):
XU Qifei; LIN Kuiran; ZHAO Guanghui
The First People’s Hospital of Pingdingshan,Pingdingshan 467000,Henan,China
關(guān)鍵詞:
跟骨;  骨折固定術(shù); 內(nèi);  跗骨竇入路;  臨床試驗(yàn)
Keywords:
calcaneus;  fracture fixation; internal;  sinus tarsal approach;  clinical trial
摘要:
目的:探討跗骨竇入路切開復(fù)位微創(chuàng)解剖接骨板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折的臨床療效與安全性。方法:回顧性分析54例SandersⅡ、Ⅲ型跟骨骨折患者的病例資料,其中采用跗骨竇入路切開復(fù)位微創(chuàng)解剖接骨板內(nèi)固定治療26例(跗骨竇入路組),采用外側(cè)擴(kuò)大的L形入路切開復(fù)位解剖鎖定接骨板內(nèi)固定治療28例(外側(cè)擴(kuò)大的L形入路組)。比較2組患者骨折至手術(shù)時間、手術(shù)時間、術(shù)中出血量、術(shù)后引流量、跟骨高度和寬度、B?ler角、Gissane角、美國足與踝關(guān)節(jié)協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足功能評分及并發(fā)癥發(fā)生情況。結(jié)果:跗骨竇入路組的骨折至手術(shù)時間、手術(shù)時間、術(shù)中出血量及術(shù)后48 h引流量均少于外側(cè)擴(kuò)大的L形入路組[(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]。術(shù)后12個月,2組患者的跟骨高度、跟骨寬度、B?ler角、Gissane角、AOFAS踝與后足功能評分比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(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]。跗骨竇入路組1例出現(xiàn)腓腸神經(jīng)損傷癥狀,經(jīng)口服營養(yǎng)神經(jīng)藥物治療后緩解,均未出現(xiàn)切口感染、皮緣壞死及延遲愈合等并發(fā)癥; 外側(cè)擴(kuò)大的L形入路組3例出現(xiàn)切口感染、皮緣壞死,其中2例經(jīng)換藥后切口愈合,1例出現(xiàn)跟骨接骨板外露,給予局部皮瓣覆蓋后愈合良好。2組患者的并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.927,P=0.336)。結(jié)論:采用跗骨竇入路切開復(fù)位微創(chuàng)解剖接骨板內(nèi)固定和外側(cè)擴(kuò)大的L形入路切開復(fù)位解剖鎖定接骨板內(nèi)固定治療SandersⅡ、Ⅲ型跟骨骨折臨床療效、安全性相當(dāng),但前者術(shù)前準(zhǔn)備時間短、手術(shù)創(chuàng)傷小、手術(shù)時間短。
Abstract:
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,B?ler 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,B?ler 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.

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更新日期/Last Update: 2020-10-20