| 跗骨窦入路结合逆骨折损伤机制复位与传统入路术式治疗跟骨骨折的临床疗效对比研究 |
| Comparative study on clinical effect of tarsal sinus approach combined with inverse fracture injury mechanism reduction and traditional approach in the treatment of calcaneal fracture |
| 投稿时间：2022-01-19 修订日期：2022-05-08 |
| DOI：10.3969/j.issn.1672-5972.2022.05.008 |
| 中文关键词: 跗骨窦入路 跟骨骨折 逆骨折损伤机制 解锁 切口并发症 |
| 英文关键词:Tarsal sinus approach Calcaneal fracture Minimally invasive Inverse fracture injury mechanism Unlock Incision complications |
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| 中文摘要: |
| 目的 探讨跗骨窦入路结合逆骨折损伤机制治疗与传统手术方式治疗跟骨骨折的疗效对比。方法 回顾分析重庆三峡医药高等专科学校附属中医院于2018年1月至2021年6月治疗的Sanders Ⅱ、Ⅲ型跟骨闭合骨折患者资料，按照手术方式分为微创组（80例）和传统组（80例）。微创组采用跗骨窦入路以跟骨结合型微创解剖板，术中逆骨折损伤机制解锁复位骨折内固定手术治疗；传统组采用经典跟骨外侧扩大“L”形入路以跟骨解剖锁定钢板手术治疗。比较两组治疗指标，包括术前准备时间、手术时间、术中出血量、住院时间；术前、术后的Böhler角、Gissane角；跟骨高度、宽度；Maryland和AOFAS评分；手术并发症率及切口甲级愈合率。结果 两组患者均获得随访，随访时间6个月。手术时间、术中出血量、住院时间微创组明显少于传统组（P＜0.05）。术后6个月，两组的跟骨Böhler角、Gissane角，跟骨高度、宽度，Maryland和AOFAS评分进行比较，差异无统计学意义（P＞0.05）。微创组手术并发症发生率（6.25%）显著低于传统组（22.50%），切口甲级愈合率（98.75%）显著高于传统组（77.50%），差异有统计学意义（P＜0.05）。结论 跗骨窦入路逆骨折损伤机制复位治疗Sanders Ⅱ、Ⅲ型跟骨骨折住院时间短，患者踝关节功能恢复快，切口并发症少，疗效显著，适于基层医院开展。 |
| 英文摘要: |
| Objective To investigate the therapeutic effect of tarsal sinus approach combined with inverse fracture injury mechanism and traditional operation in the treatment of calcaneal fracture.Methods The records of patients with Sanders type Ⅱ and Ⅲ calcaneal closed fractures treated at the Affiliated Hospital of Traditional Chinese Medicine of Chongqing Three Gorges Medical College between January 2018 and June 2021 were reviewed and divided into minimally invasive group (n=80) and traditional group (n=80) according to the surgical methods. The minimally invasive group was treated with a tarsal sinus approach using a minimally invasive anatomical plate of calcaneal union type with intraoperative reverse fracture injury mechanism unlocking reduction and internal fixation. The conventional group was surgically treated with a classical lateral calcaneal extended "L"-shaped approach with a calcaneal anatomical locking plate. The treatment parameters including preoperative preparation time, operative time, intraoperative blood loss, length of hospital stay; preoperative and postoperative Böhler angle, Gissane angle; calcaneal height, width; Maryland and AOFAS scores; surgical complication rate and grade A wound healing rate were compared between the two groups.Results Both groups were followed up for 6 months. The operation time, intraoperative bleeding and hospitalization time in the minimally invasive group were significantly less than those in the traditional group (P<0.05). At 6 months after operation, there was no significant difference in calcaneal Böhler angle, Gissane angle, calcaneal height and width, Maryland and AOFAS scores between the two groups (P>0.05). The incidence of surgical complications in the minimally invasive group was 6.25%, which was significantly lower than 22.50% in the traditional group; and the grade A wound healing rate was 98.75%, which was significantly higher than 77.50% in the traditional group (P<0.05).Conclusion Mechanism of reverse fracture injury using the tarsal sinus approach reduction treatment of calcaneal fractures has a short hospital stay, and the patients' functional recovery of the ankle joint is rapid, with few complications of the incision and significant efficacy, and they are suitable for the development of primary hospitals. |
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