Clinical effect observation of internal fixation with steel plate by minimally incision tarsal sinus approach in treatment of patients with calcaneal fracture
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摘要:目的 探讨经跗骨窦微创小切口入路行钢板内固定术治疗跟骨骨折的临床效果。方法 将104例跟骨骨折患者随机分为A组与B组。A组采取经跗骨窦小切口入路行钢板内固定术, B组采用外侧“L”型切口入路行钢板内固定术。比较2组手术时间、切口长度、伤口愈合情况; 比较2组术后第3、12个月的Bohler角、Gissane角变化情况; 结合Maryland评分比较2组优良率; 比较2组术后并发症的发生情况。结果 A组患者平均手术时间、平均切口长度及平均切口愈合时间显著优于B组(P < 0.05)。A组术后第3、12个月Maryland评分均显著高于B组(P < 0.05)。术后3个月, A组优良率达到86.5%, B组为71.2%; 术后12个月, 2组优良均为100.0%。术后第12个月时，跟骨侧轴位X线片检查提示, 2组Bohler角、Gissane角比较，差异无统计学意义(P>0.05)。A组早期并发症的发生率为11.5%, 显著低于B组的26.9%(P < 0.05)。结论 经跗骨窦微创小切口入路行钢板内固定术可暴露后关节面及前外侧骨骨片，具有切口长度小、并发症少、术后康复快等优势。Abstract:Objective To explore the clinical effect of internal fixation with steel plate by minimally incision tarsal sinus approach in treatment of patients with calcaneal fracture.Methods Totally 104 patients with calcaneal fracture were randomly divided into group A and group B. Patients in group A were treated with internal fixation with steel plate by minimally incision tarsal sinus approach, while those in group B were treated with internal fixation with steel plate by lateral L-type incision approach. The operation time, incision length and wound healing condition were compared between the two groups. The changes of Bohler angle and Gissane angle at 3 and 12 months after operation were compared between the two groups. The excellent and good rate of the two groups was compared based on Maryland score, and the incidence rate of postoperative complications was compared between the two groups.Results The average operation time, average incision length and average incision healing time of group A were significantly better than those of group B (P < 0.05). Maryland scores in group A were significantly higher than those in group B at 3 and 12 months after operation (P < 0.05). Three months after operation, the excellent and good rate of group A and group B was 86.5% and 71.2% respectively, and 12 months after operation, the excellent and good rate of both groups was 100.0%. At 12 months after operation, there was no significant difference in Bohler angle and Gissane angle between the two groups (P>0.05). The incidence rate of complications in early period in group A was 11.5%, which was significantly lower than 26.9% in group B (P < 0.05).Conclusion Internal fixation with steel plate by minimally incision tarsal sinus approach can expose the posterior articular surface and anterolateral bone fragments, and has the advantages of small incision length, less complications and quicker postoperative recovery.
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表 1 2组受试者基线资料比较(x±s)[n(%)]
基线资料 A组(n=52) B组(n=52) 年龄/岁 41.6±9.4 44.1±11.8 女 9(17.3) 12(23.1) BMI/(kg/m2) 24.4±4.1 24.1±4.5 Sanders分型 Ⅱ型 19(36.5) 22(42.3) Ⅲ型 24(46.2) 25(48.1) Ⅳ型 9(17.3) 5(9.6) 伤侧 左侧 25(48.0) 26(50.0) 右侧 27(52.0) 26(50.0) 损伤原因 交通伤 12(23.1) 15(28.8) 高处坠落伤 40(76.9) 37(71.2) 伤后至手术时间/d 3.8±1.1 4.0±1.2 Bohler角/° 13.4±6.5 15.4±7.2 Gissane角/° 94.2±10.8 93.9±9.8 
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表 2 2组患者围术期指标比较(x±s)
指标 A组(n=52) B组(n=52) 平均手术时间/min 70.3±9.5 79.1±10.2* 平均切口长度/cm 4.5±0.3 9.2±0.4* 平均切口愈合时间/d 13.8±5.1 17.4±6.2* 与A组比较, *P < 0.05。
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