摘要
[目的]探讨比较跗骨窦入路与外侧L形入路开放复位内固定治疗跟骨骨折的效果。[方法]回顾性分析研究2014年8月~2017年11月在本院行开放复位锁定钢板内固定治疗的跟骨骨折患者62例,其中,经跗骨窦入路32例,经外侧L形入路30例。比较两组患者治疗效果。[结果]两组患者均顺利手术。跗骨窦组的术前准备时间、手术时间、手术失血量显著少于L形切口组(P<0.05),跗骨窦组患者无腓肠神经损伤、无切口皮缘坏死者,仅1例术后发生切口浅表感染;而L形切口组,发生腓肠神经损伤1例、局部皮肤坏死3例,切口浅表感染2例,两组术后早期并发症发生率分别为3.13%和20.00%,差异有统计学意义(P<0.05)。随访12~18个月,跗骨窦组患肢完全负重时间显著早于L形切口组(P<0.05)。随术后时间延长,两组患者的AOFS评分均显著增加(P<0.05)。术后3个月和末次随访时,跗骨窦组的AOFS评分显著高于L形切口组(P<0.05)。影像评估方面,两组患者末次随访时跟骨Bohler角和Gissane角均较术前显著增加(P<0.05)。相应时间点两组间跟骨Bohler角和Gissane角的差异无统计学意义(P>0.05)。[结论]采用跗骨窦入路插入锁定钢板治疗跟骨关节内骨折是一种有效、安全、可靠的方法,其相关切口并发症的发生率低于经外侧L形入路。
[Objective] To compare the clinical outcomes of the tarsal sinus approach versus the lateral L-shaped approach in open reduction and internal fixation(ORIF) with locking plate for calcaneal fracture.[Methods] A retrospective study was done on 62 patients who underwent ORIF with locking plate for unilateral closed calcaneal fractures from August 2014 to November 2017 in our hospital. Of them, 32 patients received ORIF through the tarsal sinus approach, 30 patients received ORIF through the lateral L-shaped approach. The clinical documentations were compared between the two groups.[Results] All the patients received a successful operation. The sinus group spent significantly shorter time for surgical preparation preoperatively and operation time, associated with significantly less intraoperative blood loss than the L-shaped group(P<0.05). No sural nerve injury and necrosis of incision skin edge happened in anyone except superficial wound infection in 1 patient of the sinus group, whereas sural nerve injury in 1, necrosis of local skin in 3 and superficial infection in 2 patients of the L-shaped group occurred, which proved statistically significant regarding the early complication rate of 3.13% versus 20.00% respectively(P<0.05). The follow up period lasted for 12~18 months. As time went postoperatively the AOFS scores significantly increased in both group(P<0.05), however, the sinus group got significantly higher AOFS score than the L-shaped group at 3 months and the latest follow up(P<0.05). In term of radiographic assessment, both Bohler’s angle and Gissane’s angle significantly increased at the latest follow-up compared with those before operation in the two group(P<0.05). No statistically significant differences were found between the two groups in the 2 parameters at any corresponding time point(P>0.05).[Conclusion] The tarsal sinus approach for ORIF with locking plate is effective, safe and reliable for calcaneal fractures, with advantage of reducing incision-related complications over the conventional lateral L-shape approach.
作者
庞晖
孙金川
吴洪彬
高加智
姜厚森
PANG Hui;SUN Jin-chuan;WU Hong-bin;GAO Jia-zhi;JIANG Hou-sen(People's Hospital of Binzhou City,Binzhou 256600,China;Traditional Chinese Medicine Hospital of Changle County,Weifang 262400,China;People's Hospital of Weifang City,Weifang 261000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第20期1877-1881,共5页
Orthopedic Journal of China
关键词
跟骨骨折
跗骨窦入路
外侧L形入路
锁定钢板
calcaneus fractures
tarsal sinus approach
lateral L-shaped approach
locking plate
