摘要
目的 比较经跗骨窦切口多枚螺钉与钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效.方法 回顾性分析自2018-06-2022-03经跗骨窦切口内固定手术治疗的61例(73足)Sanders Ⅱ、Ⅲ型跟骨骨折,其中31例采用多枚螺钉内固定(螺钉组),30例采用钢板内固定(钢板组).记录并比较两组手术时间、术中出血量、术后48 h疼痛VAS评分、住院时间、骨折愈合时间、术后并发症发生情况,以及术后3 d、6个月跟骨Böhler角和Gissane角、术后12个月踝与后足功能AOFAS评分.结果 61例均获得随访,随访时间12～16个月,平均14.17个月.螺钉组手术时间、术中出血量、术后48 h疼痛VAS评分、住院时间方面均优于钢板组,差异有统计学意义(P＜0.05),但两组骨折愈合时间差异无统计学意义(P＞0.05).所有患者均于术后3个月基本达到骨折有效愈合,术后6个月均实现完全临床愈合、骨折线消失,随访过程中均无复位丢失情况,跟骨的长宽高恢复良好,两组术后3d、6个月跟骨Böhler角和Gissane角差异无统计学意义(P＞0.05).螺钉组术后12个月踝与后足功能AOFAS评分为46～98(85.22±14.19)分,钢板组为43～99(83.57±17.62)分.螺钉组发生足背外侧皮神经损伤1例、切口愈合不良1例、行走痛1例、创伤性关节炎2例.钢板组发生足背外侧皮神经损伤3例、皮肤坏死1例、切口愈合不良及脂肪液化4例、跟痛及行走痛3例、创伤性关节炎2例,螺钉组术后并发症发生率明显低于钢板组,差异有统计学意义(x2=4.263,P=0.037).结论 经跗骨窦切口多枚螺钉与钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折均可取得良好的临床效果,但是与钢板固定相比,螺钉固定具有术前等待手术时间短、受软组织条件限制少、手术创口小、患者术后恢复快、软组织并发症少等优点.
Abstract
Objective To compare the clinical efficacy of multiple screw and plate internal fixation through tarsal sinus inci-sion in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures.Methods A retrospective analysis of 61 cases(73 feet)of Sanders type Ⅱ and Ⅲ calcaneal fractures treated with internal fixation surgery through tarsal sinus incision from June 2018 to March 2022 was conducted.Among them,31 cases were treated with multiple screws(screw group)and 30 cases were treated with plate internal fixation(plate group).The surgical time,intraoperative blood loss,VAS score for pain at 48 hours after sur-gery,length of hospital stay,fracture healing time,incidence of postoperative complications between two groups,as well as the Böhler angle and Gissane angle of the calcaneus at 3 days and 6 months after surgery,as well as the AOFAS scores for ankle and hind foot function at 12 months after surgery were recorded and compared.Results All 61 cases were followed up for 12-16 months,with an average of 14.17 months.The screw group had better surgical time,intraoperative blood loss,VAS score for pain at 48 hours after surgery,and hospital stay than the plate group,with statistically significant differences(P＜0.05),but there was no statistically significant difference in fracture healing time between the two groups(P＞0.05).All patients achieved effec-tive fracture healing at 3 months after surgery,and achieved complete clinical healing and disappearance of fracture lines at 6 months after surgery.There was no loss of fracture reduction during follow-up,and the length,width,and height of the calca-neus recovered well.There was no statistically significant difference in Böhler angle and Gissane angle between the two groups at 3 days and 6 months after surgery(P＞0.05).The AOFAS score for ankle and hind foot function at 12 months after surgery was 46-98(85.22±14.19)points in the screw group and 43-99(83.57±17.62)points in the plate group.There were 1 case of lateral dorsal foot cutaneous nerve injury,1 case of poor incision healing,1 case of walking pain,and 2 cases of traumatic arthritis oc-curred in the screw group.In the plate group,there were 3 cases of lateral dorsal foot cutaneous nerve injury,1 case of skin ne-crosis,4 cases of poor incision healing and fat liquefaction,3 cases of heel pain and walking pain,and 2 cases of traumatic ar-thritis.The incidence of postoperative complications in the screw group was significantly lower than that in the plate group,and the difference was statistically significant(x2=4.263,P=0.037).Conclusion Both multiple screw and plate internal fixation through the tarsal sinus incision can achieve good clinical results in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures.However,compared with plate fixation,screw fixation has advantages such as shorter preoperative waiting time,less limitation by soft tissue conditions,smaller surgical wounds,faster postoperative recovery and fewer soft tissue complications.
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