改良跗骨窦入路治疗SandersⅡ～Ⅲ型跟骨骨折疗效分析
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摘要
目的探讨改良跗骨窦入路与传统跗骨窦入路治疗SandersⅡ～Ⅲ型跟骨骨折的近期临床疗效。方法选取2015年1月—2017年8月符合选择标准的53例SandersⅡ～Ⅲ型跟骨骨折患者,采用随机数字表法将患者分为观察组(21例,采用从腓骨长短肌腱下方暴露距下关节后对骨折复位的改良跗骨窦入路)和对照组(32例,采用传统跗骨窦入路)。两组患者性别、年龄、侧别、致伤原因、骨折分型、受伤至手术时间以及术前B?hler角、Gissane角、疼痛视觉模拟评分(VAS)等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术后引流量、手术相关并发症,术后B?hler角、Gissane角及术后角度改善值;并使用VAS评分、美国矫形足踝协会(AOFAS)踝与后足评分及简明健康调查量表(SF-36量表)评价疗效。结果 53例患者均顺利完成手术,无血管神经损伤、围手术期死亡等严重并发症。两组患者手术时间及术后引流量比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间12～36个月,平均17个月。术后未发生骨折移位、内固定失败、骨折畸形愈合等;所有患者均未行二期关节融合手术。两组骨折愈合时间比较差异无统计学意义(t=0.30,P=0.77)。两组术后2 d B?hler角、Gissane角均较术前显著改善(P<0.05);但观察组术后2 d B?hler角、Gissane角及改善值与对照组比较差异均无统计学意义(P>0.05)。两组术后24 h及1年VAS评分均较术前显著改善(P<0.05);术后24 h及1年两组VAS评分比较差异均无统计学意义(P>0.05)。两组术后1年AOFAS评分比较差异无统计学意义(t=1.46,P=0.15);但观察组术后1年SF-36量表评分显著高于对照组(t=2.08,P=0.04)。末次随访时,观察组2例、对照组8例患者出现距下关节僵硬或疼痛,两组发生率比较差异无统计学意义(χ2=1.98,P=0.16)。结论采用改良跗骨窦入路治疗SandersⅡ～Ⅲ型跟骨骨折,具有创伤小、直视下复位清晰、复位固定可靠、切口并发症少等优点。
Objective To investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures. Methods Between January2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group(21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group(32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative B?hler angle, Gissane angle, visual analogue scale(VAS) core(P>0.05),which were comparable. The operation time, postoperative drainage volume, postoperative B?hler angle, Gissane angle,and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society(AOFAS) score, and short-form 36 health survey scale(SF-36) score were used to evaluate the effectiveness. Results All the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups(P>0.05). Patients in both groups were followed up 12-36 months(mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups(t=0.30, P=0.77). The postoperative B?hler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation(P<0.05); however, there was no significant difference in B?hler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation(P>0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups(P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation(P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation(t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group(t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups(χ2=1.98, P=0.16). Conclusion The modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.
Objective To investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures. Methods Between January2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group(21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group(32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative B?hler angle, Gissane angle, visual analogue scale(VAS) core(P>0.05),which were comparable. The operation time, postoperative drainage volume, postoperative B?hler angle, Gissane angle,and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society(AOFAS) score, and short-form 36 health survey scale(SF-36) score were used to evaluate the effectiveness. Results All the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups(P>0.05). Patients in both groups were followed up 12-36 months(mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups(t=0.30, P=0.77). The postoperative B?hler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation(P<0.05); however, there was no significant difference in B?hler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation(P>0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups(P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation(P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation(t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group(t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups(χ2=1.98, P=0.16). Conclusion The modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.
引文
1 Misselyn D, Nijs S, Fieuws S, et al. Improved interobserver reliability of the Sanders classification in calcaneal fractures using segmented three-dimensional prints. J Foot Ankle Surg, 2018,57(3):440-444.
2 Cruz M, Cruz G, Cruz F, et al. Lateral approach to the maxillary sinus and mandibular canal in severely atrophied posterior alveolar bone. Int J Oral Maxillofac Implants, 2018, 33(2):412-428.
3 Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures:long-term(10-20 years)results in 108 fractures using a prognostic CT classification. J Orthop Trauma, 2014, 28(10):551-563.
4 Crosby LA, Fitzgibbons T. Intraarticular calcaneal fractures. Clin Orthop Relat Res, 1993,(290):47-54.
5董福,陆春,朱金荣,等.距下关节后侧人路关节镜辅助下微创治疗跟骨骨折.中国修复重建外科杂志,2017, 31(1):36-41.
6 Bai L, Hou YL, Lin GH, et al. Sinus tarsi approach(STA)versusextensile lateral approach(ELA)for treatment of closed displaced intra-articular calcaneal fractures(DIACF):A meta-analysis.Orthop Traumatol Surg Res, 2018, 104(2):239-244.
7 Rein S, Manthey S, Zwipp H, et al. Distribution of sensory nerve endings around the human sinus tarsi:a cadaver study. J Anat,2014, 224(4):499-508.
8孙振辉,赵成礼,陈亦飞,等.载距突螺钉固定跟骨骨折恒定骨折块的植入方法研究.中国修复重建外科杂志,2018, 32(5):581-586.
9 Zhang F, Tian H, Li S, et al. Meta-analysis of two surgical approaches for calcaneal fractures:sinus tarsi versus extensile lateral approach. ANZ J Surg, 2017, 87(3):126-131.
10 LIllert T, Rammelt S, Drewes T, et al. Stability of locking and nonlocking plates in an osteoporotic calcaneal fracture model. Foot Ankle Int, 2011, 32(3):307-313.
11 Richter M, Gosling T, Zech S, et al. A comparison of plates with and without locking screws in a calcaneal fracture model. Foot Ankle Int, 2005,26(4):309-319.
12 Meraj A, Zahid M, Ahmad S. Management of intraarticular calcaneal fractures by minimally invasive sinus tarsi approach-early results. Malays Orthop J, 2012, 6(1):13-17.
13 Heitz C, Weber A, Dini L, et al. Juvenile nasopharyngeal angiofibroma with sphenoid sinus invasion and protrusion:treatment approach with Le Fort I osteotomy. J Craniofac Surg,2018,29(4):e405-e408.
14周海超,任昊旸,李兵,等.内侧撑开技术联合跗骨窦入路治疗跟骨关节内骨折.中国修复重建外科杂志,2016, 30(7):830-835.
15 Yu QQ, Guan G, Zhang NK, et al. Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma.Eur Arch Otorhinolaryngol, 2018, 275(9):2297-2302.
2 Cruz M, Cruz G, Cruz F, et al. Lateral approach to the maxillary sinus and mandibular canal in severely atrophied posterior alveolar bone. Int J Oral Maxillofac Implants, 2018, 33(2):412-428.
3 Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures:long-term(10-20 years)results in 108 fractures using a prognostic CT classification. J Orthop Trauma, 2014, 28(10):551-563.
4 Crosby LA, Fitzgibbons T. Intraarticular calcaneal fractures. Clin Orthop Relat Res, 1993,(290):47-54.
5董福,陆春,朱金荣,等.距下关节后侧人路关节镜辅助下微创治疗跟骨骨折.中国修复重建外科杂志,2017, 31(1):36-41.
6 Bai L, Hou YL, Lin GH, et al. Sinus tarsi approach(STA)versusextensile lateral approach(ELA)for treatment of closed displaced intra-articular calcaneal fractures(DIACF):A meta-analysis.Orthop Traumatol Surg Res, 2018, 104(2):239-244.
7 Rein S, Manthey S, Zwipp H, et al. Distribution of sensory nerve endings around the human sinus tarsi:a cadaver study. J Anat,2014, 224(4):499-508.
8孙振辉,赵成礼,陈亦飞,等.载距突螺钉固定跟骨骨折恒定骨折块的植入方法研究.中国修复重建外科杂志,2018, 32(5):581-586.
9 Zhang F, Tian H, Li S, et al. Meta-analysis of two surgical approaches for calcaneal fractures:sinus tarsi versus extensile lateral approach. ANZ J Surg, 2017, 87(3):126-131.
10 LIllert T, Rammelt S, Drewes T, et al. Stability of locking and nonlocking plates in an osteoporotic calcaneal fracture model. Foot Ankle Int, 2011, 32(3):307-313.
11 Richter M, Gosling T, Zech S, et al. A comparison of plates with and without locking screws in a calcaneal fracture model. Foot Ankle Int, 2005,26(4):309-319.
12 Meraj A, Zahid M, Ahmad S. Management of intraarticular calcaneal fractures by minimally invasive sinus tarsi approach-early results. Malays Orthop J, 2012, 6(1):13-17.
13 Heitz C, Weber A, Dini L, et al. Juvenile nasopharyngeal angiofibroma with sphenoid sinus invasion and protrusion:treatment approach with Le Fort I osteotomy. J Craniofac Surg,2018,29(4):e405-e408.
14周海超,任昊旸,李兵,等.内侧撑开技术联合跗骨窦入路治疗跟骨关节内骨折.中国修复重建外科杂志,2016, 30(7):830-835.
15 Yu QQ, Guan G, Zhang NK, et al. Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma.Eur Arch Otorhinolaryngol, 2018, 275(9):2297-2302.