经跗骨窦小切口内固定微创术治疗SanderⅢ型跟骨骨折的疗效
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摘要
目的:探讨经跗骨窦小切口内固定微创术治疗SanderⅢ型跟骨骨折的效果。方法:收集160例SanderⅢ型跟骨骨折患者临床资料,按手术方式不同将其分为对照组和实验组,每组各80例。对照组采用常规外侧"L"形切口钢板内固定治疗,实验组采用经跗骨窦小切口空心钉内固定微创术治疗。比较两组手术时间、出血量、愈合时间、住院时间及术后并发症发生情况,测量两组Bohler角、Cissane角度和跟骨宽度改善情况。术后随访1年,根据Maryfand评分标准评估两组手术疗效。结果:两组均成功完成手术,组间住院时间、骨折愈合时间比较,差异无统计学意义(P>0.05),但实验组手术时间、出血量、术后并发症率低于对照组,差异具有统计学意义(P<0.05);两组术后Bohler角、Cissane角度均较术前升高,跟骨宽度较术前降低,差异具有统计学意义(P<0.05),但两组间的上述骨解剖测量数据相比较,差异均无统计学意义(P>0.05);截至1年随访期末,总随访率95.63%(153/160),两组Maryfand评分优良率相较,差异无统计学意义(P>0.05)。结论:经跗骨窦小切口内固定微创术治疗SanderⅢ型跟骨骨折的近期疗效和常规"L"形切口钢板内固定相接近,但前者可缩短手术时间、减少出血量和降低并发症,体现出微创、安全性好的优点。
Objective:To investigate the effect of minimally invasive internal fixation through small tarsal sinus incision on Sander type III calcaneal fracture.Methods:160 cases of Sander Ⅲ calcaneal fracture were selected and divided into the control group and the experimental group randomly,and each group had 80 cases.The patients in the control group were treated with conventional lateral L shaped incision,while the patients in the experimental group were treated with minimally invasive internal fixation through small tarsal sinus incision.The operation time,volume of bleeding,healing time,time of hospitalization and postoperative complications were compared between the two groups.The improvement of Bohler angles,Cissane angles and calcaneus width in two groups were measured.The patients were followed up for 1 years,and the operative effect of two groups were evaluated according to the Maryfand score.Results:The operation was completed successfully in the two groups.There was no significant difference in hospital stay and fracture healing time between groups(P>0.05).However,the operation time,bleeding volume and complication rate of the experimental group were lower than those of the control group,and the difference was statistically significant(P<0.05).The postoperative Bohler angle and Cissane angle increased and calcaneal width decreased in both groups(P<0.05),but there was no significant difference between the two groups in the above-mentioned bone anatomical measurements(P>0.05).At the end of the one-year follow-up period,the overall follow-up rate was 95.63%(153/160).There was no significant difference in the Maryfand score between the two groups(P>0.05).Conclusion:The short-term effect of minimally invasive internal fixation through tarsal sinus small incision for Sander type III calcaneal fracture is similar to that of conventional "L" incision plate internal fixation,but the former can shorten the operation time,reduce the amount of bleeding and reduce complications,which shows the advantages of minimally invasive and safe.
Objective:To investigate the effect of minimally invasive internal fixation through small tarsal sinus incision on Sander type III calcaneal fracture.Methods:160 cases of Sander Ⅲ calcaneal fracture were selected and divided into the control group and the experimental group randomly,and each group had 80 cases.The patients in the control group were treated with conventional lateral L shaped incision,while the patients in the experimental group were treated with minimally invasive internal fixation through small tarsal sinus incision.The operation time,volume of bleeding,healing time,time of hospitalization and postoperative complications were compared between the two groups.The improvement of Bohler angles,Cissane angles and calcaneus width in two groups were measured.The patients were followed up for 1 years,and the operative effect of two groups were evaluated according to the Maryfand score.Results:The operation was completed successfully in the two groups.There was no significant difference in hospital stay and fracture healing time between groups(P>0.05).However,the operation time,bleeding volume and complication rate of the experimental group were lower than those of the control group,and the difference was statistically significant(P<0.05).The postoperative Bohler angle and Cissane angle increased and calcaneal width decreased in both groups(P<0.05),but there was no significant difference between the two groups in the above-mentioned bone anatomical measurements(P>0.05).At the end of the one-year follow-up period,the overall follow-up rate was 95.63%(153/160).There was no significant difference in the Maryfand score between the two groups(P>0.05).Conclusion:The short-term effect of minimally invasive internal fixation through tarsal sinus small incision for Sander type III calcaneal fracture is similar to that of conventional "L" incision plate internal fixation,but the former can shorten the operation time,reduce the amount of bleeding and reduce complications,which shows the advantages of minimally invasive and safe.
引文
[1] 孙昌俊,李力更,毕若杰,等.“L”入路与“八字”微创入路治疗跟骨骨折的比较[J].中国医学科学院学报,2015,37(6):733-736.
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[3] 李伟康,周业金,宁仁德,等.跗骨窦切口联合空心钉治疗跟骨关节内骨折[J].临床骨科杂志,2017,20(2):217-220.
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[6] Meng Q,Wang Q,Wu X,et al.Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture[J].Medicine,2018,97(13):e0175.
[7] 巩金鹏,舒和喜,杨勇,等.跟骨骨折诊治的争议与进展[J].国际骨科学杂志,2015,36(5):361-364.
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[9] 钱鹍鹏.经跗骨窦小切口治疗跟骨骨折的临床分析[J].创伤外科杂志,2017,19(6):474,481.
[10] Yue Z,Tang Y,Hu Z,et al.Sanders type ⅢAB calcaneal fracture without broken lateral wall:A case report and review of literature[J].Medicine,2018,97(7):e9926.
[11] 陈明,邓葵,曾晚辉,等.微创跗骨窦小切口手法复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华外科杂志,2017,55(3):220-223.
[12] Zwipp H,Pa?a L,?ilka L,et al.Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures[J].Journal of Orthopaedic Trauma,2016,30(3):e88.
[13] 徐浩,蒋元斌,刘耀辉,等.传统外侧“L”形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药,2015,55(1):86-88.
[14] Su J,Cao X.Can operations achieve good outcomes in elderly patients with Sanders II-Ⅲ calcaneal fractures?[J].Medicine,2017,96(29):e7553.
[15] 侯正轩,李建波,刘宁波,等.跗骨窦联合外侧小切口治疗Sanders Ⅲ型跟骨骨折[J].实用骨科杂志,2018,24(1):25-30.
[2] 吴和平,李芬芳,孙惠萍,等.跟骨骨折术后早期康复护理[J].护士进修杂志,2015,23(18):1697-1699.
[3] 李伟康,周业金,宁仁德,等.跗骨窦切口联合空心钉治疗跟骨关节内骨折[J].临床骨科杂志,2017,20(2):217-220.
[4] Zhang F,Tian H,Li S,et al.Meta-analysis of two surgical approaches for calcaneal fractures:sinus tarsi versus extensile lateral approach[J].Anz Journal of Surgery,2017,87(3):14-18.
[5] 谭新欢,聂伟志,朱育林,等.跟骨骨折微创治疗的研究进展[J].中医正骨,2015,24(5):73-76.
[6] Meng Q,Wang Q,Wu X,et al.Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture[J].Medicine,2018,97(13):e0175.
[7] 巩金鹏,舒和喜,杨勇,等.跟骨骨折诊治的争议与进展[J].国际骨科学杂志,2015,36(5):361-364.
[8] Mitchell PM,O?Neill DE,Gallagher B,et al.Pathoanatomy of the Tongue-type Calcaneus Fracture:Assessment Using 2 and 3-dimensional Computed Tomography[J].Journal of Orthopaedic Trauma,2018,13(1):31-34.
[9] 钱鹍鹏.经跗骨窦小切口治疗跟骨骨折的临床分析[J].创伤外科杂志,2017,19(6):474,481.
[10] Yue Z,Tang Y,Hu Z,et al.Sanders type ⅢAB calcaneal fracture without broken lateral wall:A case report and review of literature[J].Medicine,2018,97(7):e9926.
[11] 陈明,邓葵,曾晚辉,等.微创跗骨窦小切口手法复位内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华外科杂志,2017,55(3):220-223.
[12] Zwipp H,Pa?a L,?ilka L,et al.Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures[J].Journal of Orthopaedic Trauma,2016,30(3):e88.
[13] 徐浩,蒋元斌,刘耀辉,等.传统外侧“L”形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的效果比较[J].山东医药,2015,55(1):86-88.
[14] Su J,Cao X.Can operations achieve good outcomes in elderly patients with Sanders II-Ⅲ calcaneal fractures?[J].Medicine,2017,96(29):e7553.
[15] 侯正轩,李建波,刘宁波,等.跗骨窦联合外侧小切口治疗Sanders Ⅲ型跟骨骨折[J].实用骨科杂志,2018,24(1):25-30.