Transtarsal sinus incision internal fixation versus translateral L-shaped incision plate internal fixation in the treatment of patients with Sanders Ⅱ to Ⅲcalcaneal fractures
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摘要:目的 比较经跗骨窦切口内固定术与经外侧“L”形切开钢板内固定术治疗SandersⅡ~Ⅲ型跟骨骨折的效果。方法 选取80例SandersⅡ~Ⅲ型跟骨骨折患者，随机分为治疗A组与治疗B组各40例。治疗A组采用经典的经外侧“L”形切口钢板内固定术治疗，治疗B组采用经跗骨窦切口空心钉内固定术治疗。比较2组手术效果。结果 治疗B组手术出血量、术后引流量显著低于治疗A组(P < 0.05)。2组术后跟骨Bohler角、Cissane角均较术前显著升高(P < 0.05), 但2组术前及术后跟骨Bohler角、Cissane角比较，差异无统计学意义(P>0.05)。治疗B组总并发症发生率低于治疗A组，差异有统计学意义(P < 0.05); 2组术后12个月Maryfand评分及优良率比较，差异无统计学意义(P>0.05)。结论 经典的经外侧“L”形切口内固定术与经跗骨窦切口内固定术治疗SandersⅡ~Ⅲ型跟骨骨折的手术效果相似，但经跗骨窦切口内固定术具有出血量少、引流量少和并发症少的优点。
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关键词:
- 跟骨骨折 /
- SandersⅡ~Ⅲ型 /
- 经跗骨窦切口内固定 /
- 外侧“L”形切口内固定 /
- 影像学 /
- 随访
Abstract:Objective To compare the effect of transtarsal sinus incision internal fixation and translateral L-shaped incision plate internal fixation in the treatment of patients with Sanders Ⅱ to Ⅲcalcaneal fractures.Methods A total of 80 patients with Sanders Ⅱto Ⅲcalcaneal fractures were selected and randomly divided into treatment group A and treatment group B. Treatment group A was treated with classical translateral L-shaped incision plate internal fixation, while treatment group B was treated with transtarsal sinus incision internal fixation by hollow nail. Surgical effect was compared between two groups.Results The bleeding volume and drainage volume in treatment group B were significantly lower than those in treatment group A (P < 0.05). The calcaneal Bohler angle and Cissane angle in both groups were significantly higher than those before operation (P < 0.05), but there were no significant differences in the calcaneal Bohler angle and Cissane angle between the two groups before and after operation (P>0.05). The incidence rate of total complications in treatment group B was significantly lower than that in treatment group A (P < 0.05), and there were no significant differences in Maryfand score, excellent and good rate between the two groups at 12 months after operation (P>0.05).Conclusion Classical translateral L-shaped incision internal fixation is similar to transtarsal sinus incision internal fixation in the treatment of Sanders Ⅱ to Ⅲcalcaneal fractures, but transtarsal sinus incision internal fixation has the advantages of less bleeding, less drainage volume and fewer complications. -
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表 1 2组手术指标比较(x±s)
组别 n 手术时间/min 手术出血量/mL 术后引流量/mL 骨折愈合时间/d 治疗A组 40 91.51±8.17 57.93±15.07 158.27±27.20 12.64±1.70 治疗B组 40 89.92±7.93 44.76±10.83* 65.72±18.30* 12.36±1.67 与治疗A组比较, *P < 0.05。 
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表 2 2组影像学跟骨Bohler角、Cissane角测量值比较(x±s)
组别 n Bohler角/° Cissane角/° 术前 术后 术前 术后 治疗A组 40 7.15±2.26 30.35±3.47* 97.92±5.35 130.24±5.94* 治疗B组 40 7.16±2.34 30.56±3.45* 98.03±5.51 129.87±5.98* 与术前比较, *P < 0.05。
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表 3 2组术后并发症及12个月随访Maryfand评分比较(x±s)[n(%)]
组别 n 手术并发症 Maryfand评分 皮瓣坏死或感染 延迟愈合 创伤性关节炎 合计 评分/分 优良 治疗A组 40 4(10.00) 2(5.00) 1(2.50) 7(17.50) 83.98±6.34 33(82.50) 治疗B组 40 1(2.50) 0 0 1(2.50)* 86.74±5.98 36(90.00) 与治疗A组比较, *P < 0.05。
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