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跗骨窦入路锁定钢板内固定治疗跟骨骨折(PDF)

《创伤外科杂志》[ISSN:/CN:]

期数:
2020年10期
页码:
767-771
栏目:
论著·临床研究
出版日期:
2020-10-20

文章信息/Info

Title:
Sinus tarsi approach combined with locking plate internal fixation in treatment of calcaneal fracture
文章编号:
1009-4237(2020)10-0767-05
作者:
张永发; 何武兵; 许志贤; 林 昊
350001 福州,福建医科大学省立临床学院、福建省立医院创伤外科、福建省急救中心急诊外科
Author(s):
ZHANG Yong-fa; HE Wu-bing; XU Zhi-xian; LIN Hao
Department of Emergency Surgery,Emergency Center of Fujian Province/ Department of Traumatic Surgery,Fujian Provincial Hospital/Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,China
关键词:
跟骨骨折;  跗骨窦;  锁定钢板;  内固定
分类号:
R 683.42
DOI:
10.3969/j.issn.1009-4237.2020.10.010
文献标识码:
A
摘要:
目的 探讨跗骨窦入路经皮斯氏针撬拨复位锁定钢板内固定治疗跟骨骨折的临床疗效。方法 回顾性分析福建省立医院创伤外科2015年12月—2018年12月收治的92例跟骨骨折患者的临床资料,男性63例,女性29例; 年龄24～72岁,平均41.9岁。均为闭合性骨折,按Sanders分型:Ⅱ型57例,Ⅲ型35例。受伤至手术时间4～14d,平均6.2d。行经跗骨窦入路复位锁定钢板内固定治疗47例(跗骨窦组),SandersⅡ型32例,Ⅲ型15例; 行经外侧入路“L”形切开复位锁定钢板内固定治疗45例(外侧组),SandersⅡ型25例,Ⅲ型20例。比较两组切口总长度、手术时间、术中出血量、住院时间、术前及术后Bohler及Gissane角(组内对比)、术后6个月骨折愈合情况、术后12个月美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分和并发症情况。结果 术后随访12～24个月,平均17.2个月。跗骨窦组和外侧组切口总长度分别为(5.7±1.2)cm和(10.4±1.5)cm(P<0.05),手术时间分别为(70.9±10.4)min和(69.6±11.9)min(P>0.05),术中出血量分别为(46.5±14.6)mL和(57.1±18.8)mL(P<0.05),住院时间分别为(13.7±2.7)d和(17.2±4.4)d(P<0.05)。跗骨窦组术前及术后Bohler角分别为(17.3±2.3)°和(26.1±3.2)°(P<0.05),Gissane角分别为(105.5±4.8)°和(121.5±15.9)°(P<0.05); 外侧组术前及术后Bohler角分别为(17.4±2.2)°和(28.9±2.0)°(P<0.05),Gissane角分别为(105.7±4.1)°和(120.5±16.9)°(P<0.05)。术后6个月所有患者骨折愈合良好。术后12个月跗骨窦组AOFAS评分:优36例,良7例,中3例,差1例,优良率91.5%; 外侧组:优30例,良10例,中4例,差1例,优良率88.9%(P>0.05)。术后并发症:跗骨窦组1例(患足疼痛感),外侧组6例(3例切口皮缘坏死、2例切口感染、1例关节僵硬),差异有统计学意义(2.1% vs.13.3%,P<0.05),两组均无足内翻畸形。结论 对于SandersⅡ、Ⅲ型跟骨骨折,跗骨窦入路经皮斯氏针撬拨复位内固定较外侧入路“L”形切开复位内固定切口更小、并发症更少、功能恢复更好,是一种微创且可靠的治疗方法。

参考文献/References

[1] Palmersheim K,Hines B,Olsen BL.Calcaneal fractures:update on current treatments [J].Clin Podiatr Med Surg,2012,29(2):205-220.
[2] Yoshimura I,Ichimura R,Kanazawa K,et al.Simultaneous use of lateral calcaneal ostectomy and subtalar arthroscopic debridement for residual pain after a calcaneal fracture[J].J Foot Ankle Surg,2015,54(1):37-40.
[3] Fuentes E,Nuñez M.Surgical technique and algorithm for treatment of displaced intra-articular calcaneal fractures using a sinus tarsi approach and plate fixation[J].Tech Foot Ankle Surg,2019,18(3):141-148.
[4] Sharr PJ,Mangupli MM,Winson IG,et al.Current management options for displaced intra-articular calcaneal fractures:non-operative,ORIF,minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis.A contemporary review[J].Foot Ankle Surg,2016,22(1):1-8.
[5] Schepers T,Den Hartog D,Vogels LMM,et al.Extended lateral approach for intra-articular calcaneal fractures:an inverse relationship between surgeon experience and wound complications[J].J Foot Ankle Surg,2013,52(2):167-171.
[6] Backes M,Schep NWL,Luitse JSK,et al.The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures[J].Arch Orthop Trauma Surg,2015,135(8):1045-1052.
[7] Mehta CR,An VVG,Phan K,et al.Extensile lateral versus sinus tarsi approach for displaced,intra-articular calcaneal fractures:a meta-analysis[J].J Orthop Surg Res,2018,13(1):243.
[8] Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[9] Yeo JH,Cho HJ,Lee KB.Comparison of two surgical approaches for displaced intra-articular calcaneal fractures:sinus tarsi versus extensile lateral approach[J].BMC Musculoskel Disord,2015,16(1):63.
[10] Yu X,Pang QJ,Chen L,et al.Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation:a review[J].J Int Med Res,2013,42(1):17-25.
[11] Li Y,Bao RH,Jiang ZQ,et al.Complications in operative fixation of calcaneal fractures[J].Pakistan J Med Sci,2016,32(4):857-862.
[12] Kwon JY,Guss D,De L.Effect of delay to definitive surgical fixation on wound complications in the treatment of closed,intra-articular calcaneus fractures[J].Foot Ankle Int,2015,36(5):508-517.
[13] Cao L,Weng W,Song S,et al.Surgical treatment of calcaneal fractures of sanders type Ⅱ and Ⅲ by a minimally invasive technique using a locking plate[J].J Foot Ankle Surg,2014,54(1):76-81.
[14] Yang Y,Zhou H,Zhang Y.The clinical comparison of extensile lateral approach and sinus tarsi approach combined with medial distraction technique for intra-articular calcaneal fractures[J].Orthop Surg,2017,2(3):77-85.
[15] Xia S,Lu Y,Wang H,et al.Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures—a randomized controlled trial[J].Int J Surg,2014,12(5):475-480.

备注/Memo

备注/Memo:
【通信作者】 林昊,E-mail:32348797@qq.com
更新日期/Last Update: 2020-10-20