[1]陈猛,王振,丁龙飞.经跗骨窦切口切开复位内固定治疗跟骨骨折的临床研究[J].中医正骨,2021,33(11):31-35.
　CHEN Meng,WANG Zhen,DING Longfei.A clinical study of open reduction and internal fixation through sinus tarsi approach for treatment of calcaneus fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(11):31-35.
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经跗骨窦切口切开复位内固定治疗跟骨骨折的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年11期
页码:
31-35
栏目:
临床研究
出版日期:
2021-11-20

文章信息/Info

Title:
A clinical study of open reduction and internal fixation through sinus tarsi approach for treatment of calcaneus fractures
作者:
陈猛; 王振; 丁龙飞
(洛阳东方医院,河南 洛阳 471003)
Author(s):
CHEN Meng; WANG Zhen; DING Longfei
Luoyang Dongfang Hospital,Luoyang 471003,Henan,China
关键词:
跟骨;  骨折固定术; 内;  跗骨窦;  手术后并发症;  临床试验
Keywords:
calcaneus;  fracture fixation; internal;  tarsal sinus;  postoperative complications;  clinical trial
摘要:
目的:观察经跗骨窦切口切开复位内固定治疗跟骨骨折的临床疗效和安全性。方法:将符合要求的84例跟骨骨折患者随机分为2组,每组42例,分别经跗骨窦切口和跟骨外侧L形切口行切开复位内固定治疗。比较2组患者的术中指标(手术时间、术中出血量、切口长度)、骨折愈合时间、影像学指标(B?ler角、Gissane角、跟骨长度、跟骨宽度、跟骨高度)、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分及并发症发生情况。结果:跗骨窦切口组的手术时间和切口长度均短于L形切口组, 术中出血量少于L形切口组[(75.06±12.38)min,(83.79±16.41)min,t=2.752,P=0.007;(7.14±1.51)cm,(16.48±2.04)cm,t=23.849,P=0.000;(36.34±10.57)mL,(79.35±12.41)mL,t=17.099,P=0.000]; 所有患者的骨折均愈合,2组患者的骨折愈合时间、术后6个月时的AOFAS踝与后足评分比较,组间差异均无统计学意义[(12.06±2.53)周,(12.34±1.98)周,t=0.565,P=0.574;(82.12±5.97)分,(80.49±6.81)分,t=1.166,P=0.247]。术前2组患者的B?ler角、Gissane角、跟骨长度、跟骨宽度及跟骨高度比较,组间差异均无统计学意义[13.25°±2.37°,13.17°±2.41°,t=0.153,P=0.879; 102.36°±8.20°,102.42°±8.29°,t=0.033,P=0.974;(64.68±3.52)mm,(64.71±3.59)mm,t=0.039,P=0.969;(39.34±2.35)mm,(39.41±2.28)mm,t=0.139,P=0.890;(33.86±3.05)mm,(33.74±3.11)mm,t=0.179,P=0.859]; 术后6个月时,2组患者的B?ler角、Gissane角、跟骨长度及跟骨高度均较术前增大,跟骨宽度较术前减小(B?ler角:t=46.604,P=0.000; t=46.087,P=0.000; Gissane角:t=11.954,P=0.000; t=10.011,P=0.000; 跟骨长度:t=4.268,P=0.000; t=3.824,P=0.000; 跟骨高度:t=8.296,P=0.000; t=8.170,P=0.000; 跟骨宽度:t=14.158,P=0.000; t=12.477,P=0.000); 术后6个月时2组患者的B?ler角、Gissane角、跟骨长度、跟骨宽度及跟骨高度比较,组间差异均无统计学意义[39.63°±2.80°,38.59°±2.64°,t=1.751,P=0.084; 121.19°±6.08°,119.72°±7.53°,t=0.984,P=0.328;(68.14±3.90)mm,(67.82±3.86)mm,t=0.378,P=0.707;(32.86±1.81)mm,(33.39±2.14)mm,t=1.226,P=0.224;(39.16±2.80)mm,(38.94±2.71)mm,t=0.366,P=0.715]。术后跗骨窦切口组1例发生切口感染、1例发生切口裂开,L形切口组3例发生切口裂开、2例发生切口皮缘坏死、2例发生切口感染、2例发生骨髓炎,跗骨窦切口组的并发症发生率低于L形切口组(χ2=5.126,P=0.024)。结论:经跗骨窦切口切开复位内固定是治疗跟骨骨折的有效方法,其疗效与经跟骨外侧L形切口切开复位内固定相当,但该术式创伤更小、并发症更少。
Abstract:
Objective:To observe the clinical curative effects and safety of open reduction and internal fixation(ORIF)through sinus tarsi approach(STA)for treatment of calcaneus fractures.Methods:Eighty-four patients with calcaneus fractures were enrolled in the study and were randomly divided into 2 groups,42 cases in each group,and they were treated with ORIF through STA(STA group)and conventional L-shaped lateral approach(CLSLA group)respectively.The operative time,intraoperative blood loss,incision length,fracture healing time,B?ler angle,Gissane angle,calcaneus length,calcaneus width,calcaneus height,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and complication incidence were compared between the 2 groups.Results:The operative time and incision length were shorter and the intraoperative blood loss was less in STA group compared to CLSLA group(75.06±12.38 vs 83.79±16.41 minutes,t=2.752,P=0.007; 7.14±1.51 vs 16.48±2.04 cm,t=23.849,P=0.000; 36.34±10.57 vs 79.35±12.41 mL,t=17.099,P=0.000).All fractures healed in the 2 groups,and there was no statistical difference in the fracture healing time and AOFAS ankle-hindfoot scores measured at 6 months after the surgery between the 2 groups(12.06±2.53 vs 12.34±1.98 weeks,t=0.565,P=0.574; 82.12±5.97 vs 80.49±6.81 points,t=1.166,P=0.247).There was no statistical difference in B?ler angle,Gissane angle,calcaneus length,calcaneus width and calcaneus height between the 2 groups before the surgery(13.25±2.37 vs 13.17±2.41 degrees,t=0.153,P=0.879; 102.36±8.20 vs 102.42±8.29 degrees,t=0.033,P=0.974; 64.68±3.52 vs 64.71±3.59 mm,t=0.039,P=0.969; 39.34±2.35 vs 39.41±2.28 mm,t=0.139,P=0.890; 33.86±3.05 vs 33.74±3.11 mm,t=0.179,P=0.859).The B?ler angle,Gissane angle,calcaneus length and calcaneus height increased,wheres the calcaneus width decreased in the 2 groups at 6 months after the surgery compared to pre-surgery(B?ler angle:t=46.604,P=0.000; t=46.087,P=0.000; Gissane angle:t=11.954,P=0.000; t=10.011,P=0.000; calcaneus length:t=4.268,P=0.000; t=3.824,P=0.000; calcaneus height:t=8.296,P=0.000; t=8.170,P=0.000; calcaneus width:t=14.158,P=0.000; t=12.477,P=0.000).There was no statistical difference in B?ler angle,Gissane angle,calcaneus length,calcaneus width and calcaneus height between the 2 groups at 6 months after the surgery(39.63±2.80 vs 38.59±2.64 degrees,t=1.751,P=0.084; 121.19±6.08 vs 119.72±7.53 degrees,t=0.984,P=0.328; 68.14±3.90 vs 67.82±3.86 mm,t=0.378,P=0.707; 32.86±1.81 vs 33.39±2.14 mm,t=1.226,P=0.224; 39.16±2.80 vs 38.94±2.71 mm,t=0.366,P=0.715).After the surgery,the incision infection(1 case)and incision dehiscence(1 case)were found in STA group,while the incision dehiscence(3 cases),skin necrosis at the incision margin(2 cases),incision infection(2 cases)and osteomyelitis(2 cases)were found in CLSLA group.The incidence rate of postoperative complications was lower in STA group compared to CLSLA group(χ2=5.126,P=0.024).Conclusion:ORIF through STA is an effective method for treatment of calcaneus fractures,and it is similar to ORIF through CLSLA in clinical curative effects,furthermore,it has the advantages of less surgical injury and postoperative complications.

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更新日期/Last Update: 1900-01-01