[1]扈延龄,刘巧聪,陈晓辉,等.跗骨窦入路和外侧“L”型入路治疗Sanders Ⅲ型跟骨骨折的疗效研究[J].中华老年骨科与康复电子杂志,2023,(03):138-144.[doi:10.3877/cma.j.issn.2096-0263.2023.03.002]
　Hu Yanling,Liu Qiaocong,Chen Xiaohui,et al.Therapeutic effect of tarsal sinus approach and lateral L approach on Sanders calcaneal fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(03):138-144.[doi:10.3877/cma.j.issn.2096-0263.2023.03.002]
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跗骨窦入路和外侧“L”型入路治疗Sanders Ⅲ型跟骨骨折的疗效研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2023年03期
页码:
138-144
栏目:
足部骨折
出版日期:
2023-06-05

文章信息/Info

Title:
Therapeutic effect of tarsal sinus approach and lateral L approach on Sanders calcaneal fracture
作者:
扈延龄; 刘巧聪; 陈晓辉; 张成栋; 梁承志; 李海燕
266000 青岛大学附属医院创伤外科
Author(s):
Hu Yanling;  Liu Qiaocong;  Chen Xiaohui;  Zhang Chengdong;  Liang Chengzhi;  Li Haiyan.
Department of Traumatology, Affiliated Hospital of Qingdao University, Qingdao 26600, China
关键词:
跗骨窦;  跟骨骨折;  微创
Keywords:
Tarsal sinus;  Calcaneal fracture;  Minimal invasive
DOI:
10.3877/cma.j.issn.2096-0263.2023.03.002
文献标志码:
A
摘要:
目的 比较跗骨窦入路和外侧扩大入路治疗SandersⅢ型跟骨骨折的临床疗效。方法 采用回顾性队列研究分析2013年1月至2016年6月32例SandersⅢ型跟骨骨折患者，将患者分为微创组或切开组，其中微创组17例采用跗骨窦入路，切开组15例采用外侧扩大“L”型入路，记录两组患者的一般资料、受伤后至手术的时间、手术时间、术后引流量、手术前后的B?hler角、Gissane角等指标，手术后的并发症情况、美国足踝外科协会（AOFAS）踝-后足评分，并对其结果进行比较。结果 所有纳入患者均获得随访，微创组与切开组平均随访时间分别为（18.3±2.6）个月和（19.6±3.3）个月。末次随访时微创组AOFAS评分为（88.2±8.5）分，切开组为（87.4±11.2）分（P＞0.05），微创组1例、切开组3例出现不同程度的距下关节炎（P＞0.05）。B?hler角的切开组与微创组经重复测量设计的方差分析，不同组别间差异没有统计学意义（F=0.010，P=0.921），不同时间点间差异有统计学意义（F=92.201，P=0.000），组别与时间点间无交互作用（F=0.166，P=0.848）。Gissane角的切开组与微创组经重复测量设计的方差分析，不同组别间差异没有统计学意义（F=0.012，P=0.912），不同时间点间差异有统计学意义（F=88.800，P=0.000），组别与时间点间无交互作用（F=0.500，P=0.060）。微创组和切开组的术后1 d、术后末次随访与术前的B?hler角、Gissane角相比较得到明显改善（P＜0.05）。术后引流量微创组为（30.5±19.3.）ml，少于切开组（150.4±41.2）ml（P＜0.05），微创组有1例患者因复位难由外踝尖下向后下弧形延长2～3 cm，微创组术后未见切口坏死感染病例，切开组有3例出现切缘坏死，1例出现皮肤浅表感染（P＜0.05）。结论 跗骨窦入路治疗SandersⅢ型跟骨骨折与外侧扩大L 型切口入路相比较在影像学恢复及患者术后功能恢复方面无明显差异，但可以明显降低术后早期切口并发症。
Abstract:
Objective To compare the clinical efficacy of tarsal sinus approach and lateral L-shape approach in the treatment of Sanders type Ⅲ calcaneal fracture. Methods A retrospective cohort study was used to analyze 32 patients with Sanders type Ⅲ calcaneal fracture from January 2013-June 2016，Patients were divided into minimally invasive group or incision group, of which 17 cases in the minimally invasive group used tarsal sinus approach and 15 cases in the incision group used lateral widened "L" approach, The general data of the two groups, the time from injury to surgery, operation time, postoperative drainage, B?hler angle and Gissane angle before and after surgery, postoperative complications, and the ankle-hind foot score of the American orthopaedic foot and ankle society (AOFAS) were recorded, and the results were compared. Results All included patients were followed, and the mean follow-up time in the minimally invasive group and the incision group was (18.3±2.6) months and (19.6±3.3) months, respectively, and there was no statistically significant difference between the two groups (P>0.05). At the last follow-up visit, the AOFAS score in the minimally invasive group was (88.2±8.5) and the incision group was (87.4±11.2), and there was no significant difference between the two groups (P>0.05), and 1 case in the minimally invasive group and 3 cases in the incision group developed different degrees of subtalar arthritis. There was no significant comparison between the two groups (P>0.05). Analysis of variance by repeated measurement design of incisional group and minimally invasive group of B?hler angle, There was no significant difference between different groups (F=0.010, P=0.921), there was significant difference between different time points (F=92.201,P=0.000), and there was no interaction between groups and time points (F=0.166, P=0.848). Analysis of variance by repeated measurement design of incisional and minimally invasive groups of Gissane angles, There was no significant difference between different groups (F=0.012, P=0.912), there was significant difference between different time points (F=88.800, P=0.000), and there was no interaction between groups and time points (F=0.500, P=0.060). The Gissane angle of B?hler’s angle was significantly improved in the minimally invasive group and the incision group at the last follow-up 1 day after surgery compared with the preoperative Gissane Angle, and the differences were statistically significant (P<0.05). The postoperative drainage was (30.5±19.3) ml in the minimally invasive group and (150.4±41.2) ml in the incisional group, the two groups were statistically significant (P<0.05). And one patient in the minimally invasive group had difficulty in repositioning the ankle by extending 2-3 cm from under the tip of the outer ankle to the posterior lower arc, the incision complications of the two groups were statistically significant (P<0.05). Conclusion No significant was found between the two groups in imaging restoration and functional recovery for Sanders type Ⅲ calcaneal fracture, but minimal invasive can significantly reduce early complications after operation.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金（32000828）
更新日期/Last Update: 2023-07-05