摘要
目的 比较跗骨窦切口微创钢板联合内侧柱经皮空心螺钉固定与外侧"L"形切口钢板固定治疗跟骨骨折的疗效差异.方法 回顾性分析2017年1月至2024年3月于浙江大学医学院附属邵逸夫医院骨科采用跗骨窦切口微创钢板联合经皮空心螺钉固定治疗Sanders分型Ⅱ～Ⅳ型跟骨骨折103例(微创组)患者的病历资料;按跟骨骨折Sanders分型1:1频数匹配选择同期接受"L"形切口钢板固定治疗跟骨骨折103例作为对照(开放组).比较两组跟骨简单骨折(Sanders分型Ⅱ型)和复杂骨折(Sanders分型Ⅲ和Ⅳ型)患者术前住院时间、手术时间、术后隐性失血量、术后住院时间、术后感染率、术后Bohler角、Gissane角、跟骨中部宽度、载距突有效固定率、术后6和12个月美国足踝外科协会(American Orthopae-dic Foot and Ankle Society,AOFAS)评分系统的踝-后足评分.结果 微创组简单骨折患者术前住院时间(3.1±1.5)d、术后住院时间(3.5±1.5)d、隐性失血量(293.3±71.4)ml、手术时间(64.4±13.2)min和术后6个月AOFAS评分(79.9±3.9)分均优于开放组的(7.1±0.7)d、(5.6±0.9)d、(408.3±101.7)ml、(91.5±24.3)min和(70.5±6.1)分(P＜0.05),术后 1年AOFAS评分的组间差异无统计学意义(P＞0.05).微创组复杂骨折患者术前住院时间(3.7±1.5)d、术后住院时间(4.0±2.0)d、隐性失血量(336.3±75.3)ml和术后6个月的 AOFAS评分(77.4±3.8)分均优于开放组的(7.6±0.9)d、(8.2±2.6)d、(441.3±89.2)ml和(64.6±8.4)分(P＜0.05),手术时间、术后1年AOFAS评分的组间差异无统计学意义(P＞0.05).开放组复杂骨折患者术前住院时间(P＜0.05)、术后住院时间(P＜0.05)均较简单骨折患者增加,而微创组复杂骨折患者手术时间较简单骨折患者延长(P＜0.05);术后6个月AOFAS评分两组内复杂骨折与简单骨折的差异均有统计学意义(P＜0.05);简单骨折和复杂骨折患者术后Bohler角、Gissane角、跟骨中部宽度的组间差异均无统计学意义(P＞0.05);微创组简单骨折患者载距突有效固定率为85.4％,优于开放组的47.4％(P＜0.05),而复杂骨折患者的组间差异无统计学意义(P＞0.05).微创组切口感染率为0,开放组发生切口感染3例(3％),差异无统计学意义(P=0.246).结论 跗骨窦切口微创钢板联合内侧柱经皮空心螺钉固定治疗跟骨骨折,具有住院时间短、手术创伤小、切口感染率低、术后短期疗效优等优点,适用于大部分Sanders分型Ⅱ～Ⅳ型跟骨骨折.
Abstract
Objective To compare the efficacy of minimally invasive steel plate combined with percutaneous hollow nail fixation through the sinus tarsi incision versus"L"-shaped incision steel plate fixation in the treatment of calcaneal fractures.Methods A retrospective analysis was conducted on 103 cases of Sanders type Ⅱ-Ⅳ calcaneal fractures treated with minimally invasive steel plate combined with percutaneous hollow nail fixation through sinus tarsi incision from January 2017 to March 2024 at the orthopedic department of Hangzhou Sir Run Run Shaw Hospital(minimally invasive group).An additional 103 cases treated with"L"-shaped incision steel plate fixation during the same period were included as controls(open group).The preoperative hos-pital stay,surgical time,postoperative hidden blood loss,postoperative hospital stay,postoperative infection rate,postoperative Bohler angle,Gissane angle,calcaneal mid-width,sustentacular effective fixation rate,and American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score at 6 and 12 months postoperatively were compared between the two groups.Results There were no statistically significant differences in age,gender,diabetes,smoking history,and body mass index between the minimally invasive group and the open group(P＞0.05).In the minimally invasive group,the preoperative hospital stay(3.1±1.5 days),postop-erative hospital stay(3.5±1.5 days),hidden blood loss(293.3±71.4 ml),surgical time(64.4±13.2 min),and AOFAS score at 6 months postoperatively(79.9±3.9)were superior to those in the open group(7.1±0.7 days,5.6±0.9 days,408.3±101.7 ml,91.5±24.3 min,and 70.5±6.1,respectively)(P＜0.05),with no significant difference in AOFAS score at 1 year postoperatively(P＞0.05).Additionally,the preoperative hospital stay(3.7±1.5 days),postoperative hospital stay(4.0±2.0 days),hidden blood loss(336.3±75.3 ml),and AOFAS score at 6 months postoperatively(77.4±3.8)in the minimally invasive group were superior to those in the open group(7.6±0.9 days,8.2±2.6 days,441.3±89.2 ml,and 64.6±8.4,respectively)(P＜0.05),with no significant difference in sur-gical time and AOFAS score at 1 year postoperatively(P＞0.05).Within-group comparisons indicated that as fracture severity in-creased,preoperative(P＜0.05)and postoperative hospital stays(P＜0.05)increased in the open group,while surgical time in-creased in the minimally invasive group(P＜0.05).AOFAS scores at 6 months postoperatively varied between complex and simple fractures in both groups(P＜0.05).There were no statistically significant differences in postoperative Bohler angle,Gissane angle,and calcaneal mid-width between the two groups(P＞0.05).The sustentacular effective fixation rate in the minimally invasive group was 85.4％,superior to 47.4％in the open group for simple fractures(P＜0.05),with no statistically significant difference for com-plex fractures(P＞0.05).The incision infection rate was 0 in the minimally invasive group compared to 3 cases(3％)in the open group,with no statistically significant difference(P=0.246).Conclusion Minimally invasive steel plate combined with percutane-ous hollow nail fixation through sinus tarsi incision for calcaneal fractures offers the advantages of shorter hospital stay,reduced surgical trauma,lower incision infection rate,and better short-term efficacy compared to open incision.It is suitable for most Sand-ers type Ⅱ-Ⅳ calcaneal fractures.
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