目的 分析跗骨窦入路(sinus tarsi approach，STA)空心钉内固定术治疗跟骨骨折的疗效，并分析影响治疗结果的相关因素。方法 选取2022年5月至2023年6月郑州大学第一附属医院骨科收治的跟骨骨折患者120例，按手术方法不同分组，将行扩展外侧入路(extended lateral approach，ELA)钢板内固定术治疗的60例作为对照组，行STA空心钉内固定术治疗的60例作为观察组，均随访6个月，比较两组足部功能、手术相关指标、并发症发生率，并依据是否发生并发症对观察组患者进行分组，分析影响STA空心钉治疗效果的相关因素。结果 观察组手术切口长度、术中出血量及切口愈合用时为(4。23±1。04)cm、(78。36±10。24)mL、(20。16±1。35)d，均少于对照组，差异有统计学意义(P＜0。05);术前两组患侧AOFAS评分与Bohler角比较，差异无统计学意义(P＞0。05)，观察组治疗6个月AOFAS评分(83。25±4。57)分，Bohler角(30。58±4。63)°，均高于对照组(P＜0。05);观察组并发症发生率25。00％，与对照组的41。67％比较，差异无统计学意义(P＞0。05);60例观察组分为并发症组(15例)、无并发症组(45例)，两组年龄、吸烟、Sanders分型、术前软组织肿胀情况、术后Bohler角及AOFAS评分比较，差异有统计学意义(P＜0。05);对上述对比有意义指标赋值，建立回归模型，结果显示较大年龄、较高Sanders分型是跟骨骨折STA空心钉内固定治疗后发生并发症的风险因子，术后较高Bohler角则是并发症发生的保护因子(P＜0。05)。结论 跟骨骨折患者应用STA空心钉内固定术治疗能明显获益，不仅能提高骨折部位修复效果、促进功能康复，还能控制并发症发生概率。影响疗效及并发症发生的因素有年龄、骨折严重程度及跟骨重建程度。
Application effect and influencing factors of tarsal sinus approach hollow nail fixation in calcaneal fracture
Objective To analyze the efficacy of sinus tarsi approach(STA)hollow nail internal fixation in the treatment of calcaneal fracture,and analyze the related factors affecting the treatment results.Methods A total of 120 patients with calcaneal fracture admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from May 2022 to June 2023 were divided into groups according to different surgical methods.60 patients receiving ex-tended lateral approach(ELA)plate internal fixation were selected as the control group,and 60 patients receiving STA hollow nail internal fixation were selected as the observation group.All patients were followed up for 6 months.The foot function,surgery-related indicators and complication rate of the two groups were compared,and the patients in the ob-servation group were divided according to whether complications occurred,and the related factors affecting the treatment effect of STA hollow nail were analyzed.Results The incision length,intraoperative blood loss and wound healing time in the observation group were(4.23±1.04)cm,(78.36±10.24)mL and(20.16±1.35)d,which were all lower than those of the control group(P＜0.05).The AOFAS score and Bohler Angle on the affected side of the two groups were compared before surgery(P＞0.05).After 6 months of treatment,the AOFAS score and Bohler Angle of the obser-vation group were(83.25±4.57)points and(30.58±4.63)degrees,both of which were higher than those of the con-trol group(P＜0.05).The complication rate in observation group was 25.00％,compared with 41.67％of control group(P＞0.05).The 60 observation groups were divided into complication group(15 cases)and uncomplication group(45 cases).Age,smoking,Sanders classification,preoperative soft tissue swelling,postoperative Bohler Angle and postopera-tive AOFAS score were statustucally significant difference between the two groups(P＜0.05).A regression model was established to assign values to the above comparative meaningful indicators.The results showed that older age and higher Sanders classification were risk factors for complications after STA hollow nail internal fixation for calcaneal fracture,and higher postoperative Bohler Angle were protective factors for complications(P＜0.05).Conclusion The application of STA hollow nail internal fixation can benefit the patients with calcaneal fracture,which can not only improve the repair effect of fracture site,promote functional rehabilitation,but also control the probability of complications.Age,fracture se-verity and degree of calcaneus reconstruction were the factors influencing the curative effect and complications.
Calcaneal fractureTarsal sinus approach hollow nail internal fixationComplicationsRisk factor
NETL
NSTL
万方数据
