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纵行切口不植骨锁定钢板内固定对跟骨骨折的短期疗效研究*
作者:蒲鹏吉 沈伟辉 肖靖 畅龙 钟旭平 
单位:韶关市第三人民医院外三科 广东 韶关 512122 
关键词:纵行切口 不植骨 跟骨骨折 并发症 
分类号:R 683
出版年,卷(期):页码:2023,40(5):497-799
摘要:

 摘要:目的 探讨应用纵行切口不植骨锁定钢板内固定治疗SandersⅡ、Ⅲ型合并距下关节面塌陷跟骨骨折的疗效。方法 选择2019年4月—2020年12月我院收治的SandersⅡ、Ⅲ型合并距下关节面塌陷的跟骨骨折患者23例,将其中符合条件的12例作为研究对象,根据手术方式的不同将其分为对照组7例与观察组5例。观察组采用纵行切口不植骨钢板内固定治疗,对照组采用跟骨外侧扩大L形切口植骨结合锁定钢板内固定治疗。比较两组手术时间,Bohler角、Gissane角、踝-后足评分(AOFAS)等术后评价指标。结果 两组手术时间比较差异无统计学意义(t=1.977,P>0.05)。两组术后Bohler角、Gissane角均较治疗前改善,组内比较差异均有统计学意义(t=-4.281、-9.037、5.413、7.634,均P<0.05);且观察组Bohler角改善优于对照组,组间比较差异有统计学意义(t=2.304,P<0.05),但两组术后Bohler角均在正常范围内,认为不具有临床意义。两组术后Gissane角、AOFAS评分比较差异均无统计学意义(t=-0.712、0.017,均P>0.05)。结论 对于合并距下关节塌陷的SandersⅡ、Ⅲ型跟骨骨折手术,纵行切口不植骨钢板内固定和传统跟骨外侧扩大L形切口相比,具有相似的手术效果,是跟骨骨折的治疗方法之一。

 Abstract:Objective To explore the efficacy of longitudinal incision without bone grafting and locking plate internal fixation in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures with subtalar articular surface collapse. Methods 23 patients with Sanders typeⅡ and Ⅲ calcaneal fracture combined with subtalar joint surface collapse admitted to our hospital from April 2019 to December 2020 were selected. Among them,12 eligible patients were selected as the study subjects, and they were divided into a control group of 7 patients and an observation group of 5 patients based on different surgical methods.The observation group was treated with longitudinal incision without bone grafting and internal fixation with steel plates. The control group was treated with an expanded L-shaped incision on the lateral side of the calcaneus and bone grafting combined with locking steel plate internal fixation. Postoperative evaluation indicators such as time of operation, Bohler angle, Gissane angle, ankle-hindfoot score(AOFAS), and etc. were compared between the two group. Results There was no statistically significant difference in the operative time between the two groups (t=1.977, P>0.05). The postoperative Bohler angle and Gissane angle improved in both groups compared with those before treatment, and the differences within the groups were statistically significant (t=-4.281, -9.037, 5.413, 7.634, all P<0.05); and the improvement of Bohler angle in the observation group was better than that in the control group, and the differences between the groups were statistically significant (t=2.304, P<0.05), but the postoperative Bohler angle in both groups were within the normal range and was not considered clinically significant. The differences in the postoperative Gissane angle and AOFAS scores were not statistically significant when compared between the two groups (t=-0.712, 0.017, both P>0.05). Conclusion For Sanders typeⅡ and Ⅲ calcaneal fractures combined with subtalar joint collapse, the longitudinal incision without bone grafting and internal fixation with steel plates has similar surgical effects compared to the traditional lateral expansion L-shaped incision of the heel, and is one of the treatment methods for calcaneal fractures.

基金项目:
?基金项目:韶关市科技计划项目(200813114531150);韶关市卫生健康科研项目(Y20019)
作者简介:
参考文献:

 参考文献

[1] 肖凯,方真华,安颖,等.跗骨窦小切口及经皮复位固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中华骨科杂志,2018,38(15):905-912.
[2 ] Sanders R. Intra-articular fractures of the calcaneus: present state of the art[J]. J Orthop Trauma,1992,6(2):252-265.
[3] Wilkinson BG,Marsh JL. Minimally invasive treatment of displaced intra-articular calcaneal fractures[J]. Orthop Clin North Am,2020,51(3):325-338.
[4] Stulik J,Stehlik J,Rysavy M,et al. Minimally invasive treatment of intra-articular fractures of the calcaneum[J]. J Bone Joint Surg Br,2006(88):1634-1641.
[5] Sivakumar BS,Wong P,Dick CG,et al. Arthroscopic reduction and percutaneous fixation of selected calcaneus fractures: surgical technique and early results[J]. J Orthop Trauma,2014,28(10):569-576.
[6] 赵宏谋,杨云峰,俞光荣.植骨与不植骨切开复位内固定治疗跟骨关节内骨折的比较研究[J].中华创伤骨科杂志,2011(8):725-729.
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