跗骨竇入路與外側L形切口入路治療Sanders Ⅱ、Ⅲ型跟骨骨折的效果比較

祝捷

[摘要]目的 比較跗骨竇入路與外側L形切口入路治療Sanders Ⅱ、Ⅲ型跟骨骨折的臨床效果。方法 選取2012年1月～2017年12月在我院診斷為跟骨骨折且行切開復位內固定手術治療的88例患者進行回顧性分析，根據手術方法的不同分為跗骨竇入路組（36例）與外側L形切口入路組（52例）。記錄兩組的手術時間、出血量和術后并發癥發生情況，測量末次隨訪時的X線跟骨骨寬、跟骨高度、B■hler角、Gissane角，并且采用美國骨科足踝外科協會（AOFAS）踝-后足評分標準（AHFS）評價術后足踝功能的恢復。結果 跗骨竇入路組的手術時間短于外側L形切口入路組，出血量少于外側L形切口入路組，術后并發癥總發生率低于外側L形切口入路組，差異均有統計學意義（P<0.05）。兩組患者的跟骨寬度、跟骨高度、B■hler角、Gissane角、AHFS評分優良率比較，差異均無統計學意義（P>0.05）。結論 跗骨竇入路與外側L形切口入路治療Sanders Ⅱ、Ⅲ型跟骨骨折均能獲得較滿意的臨床效果，但經跗骨竇入路具有手術時間短、術中出血少、術后并發癥少等優勢。

[關鍵詞]跟骨骨折，跗骨竇入路;外側L形切口入路;并發癥

[中圖分類號] R683.42? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-4721（2019）8（c）-0056-04

[Abstract] Objective To compare the clinical effect of tarsal sinus approach and lateral L-incision approach in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods Retrospective analysis was conducted on 88 patients diagnosed with calcaneal fracture and treated with open reduction and internal fixation in our hospital from January 2012 to December 2017. According to different surgical approach， the patients were divided into the tarsal sinus approach group （n=36） and the lateral L-shaped incision group （n=52）. The operation time， bleeding volume and postoperative complications were recorded in the two groups. The calcaneal width， calcaneal height， B■hler and Gissane angle were measured at the last follow-up， and the recovery of ankle function was evaluated by American orthopaedic foot and ankle society （AOFAS） ankle-hind foot scale （AHFS）. Results The operation time of the tarsal sinus approach group was shorter than that in the lateral L-shaped incision group， the amount of bleeding of the tarsal sinus approach group was less than that of the lateral L-shaped incision group， and the total incidence of postoperative complications of the tarsal sinus approach group was lower than that of the lateral L-incision group， the difference was statistically significant （P<0.05）. There were no significant differences in the calcaneal width， calcaneal height， B■hler， Gissane angle and the excellent and good rate of AHFS score between the two groups （P>0.05）. Conclusion Both tarsal sinus approach and lateral L-incision approach can achieve satisfactory clinical results in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures， but the tarsal sinus approach has the advantages of short operation time， less intraoperative bleeding and fewer postoperative complications.

[Key words] Calcaneal fracture; Tarsal sinus approach; Lateral L-incision approach; Complications

跟骨骨折占跗骨骨折的60%，占人體骨折的1%，其中75%以上為關節內骨折，主要由高處跌倒、暴力撞擊和打砸傷造成。跟骨骨折嚴重破壞跟距關節的解剖關系，致殘率較高[1]。切開復位內固定是目前治療有移位的跟骨關節內骨折的最有效方法，最流行的手術是跟骨外側L形切口入路，盡管術中采用了非接觸技術等保護措施，但仍存在嚴重軟組織損傷、并發癥較高等風險[2]。隨著微創概念的普及和應用，許多學者報道，經跗骨竇入路微創治療跟骨骨折能夠取得較好的效果[3]。……