背景:目前切开复位内固定术是临床最常见的跟骨骨折治疗方案,但是手术并发症一直困扰着临床工作者,因此选择合适的手术方案对于减少术后并发症、提高患者疗效具有重要意义.目的:比较改良经跗骨窦微创小切口空心钉内固定与传统外侧L形切口钢板内固定治疗跟骨骨折的效果.方法:选择单侧跟骨骨折(SandersⅡ、Ⅲ型)患者68例,其中改良经跗骨窦微创小切口入路空心钉内固定治疗33例(改良组),经传统外侧L形切口入路钢板内固定治疗35例(传统组).比较两组手术时间、出血量及目测类比评分,及两组手术前后AOFAS 评分、Bohler角、Gissane角及术后并发症发生情况的差异,分别对患者内固定后疼痛、关节活动度、踝关节稳定性等进行评价.结果与结论:①两组内固定后6月AOFAS评分优良率均高于内固定前(P < 0.05),且改良组AOFAS评分高于传统组(P < 0.05);②改良组内固定后1周、6个月、12个月的Bohler角、Gissane角及跟骨宽度与传统组同期相比较有明显改善(P < 0.05);③两组手术时间的比较相差不大,但在出血量、手术时间与目测类比评分上,改良组相比传统组均显著改善(P < 0.05);④改良组内固定后并发症发生率明显少于传统组(P < 0.05);⑤结果说明,与传统 L 形切口钢板内固定相比,改良经跗骨窦微创小切口空心钉内固定治疗跟骨骨折在减轻疼痛、提供关节活动度等方面能够取得更好的临床效果,使跟骨关节面有更强的稳定性.%BACKGROUND: Open reduction and internal fixation is commonest surgical method for calcaneal fractures, but its postoperative complications are troublesome. Thereafter, choosing an appropriate treatment scheme is of great significance for reducing postoperative complications and promoting patients' functional recovery. OBJECTIVE: To compare the curative efficacy of the modified minimally invasive internal fixation with cannulated screws through tarsal sinus and traditional extended lateral "L-shape" incision with plate fixation for calcaneal fractures. METHODS: Sixty-eight cases of unilateral calcaneal fractures (Sanders II and III) were selected, followed by treated with modified minimally invasive internal fixation with cannulated screws through tarsal sinus (modified group, n=33) or traditional extended lateral "L-shape" incision with plate fixation (traditional group, n=35). The operation time, blood loss, and Visual Analogue Scale scores were compared between two groups; the preoperarive and postoperative American Orthopedic Foot and Ankle Society scores, Bohler angle, and Gissane angle as well as postoperative complications were detected and compared between both groups. Besides, the postoperative pain, range of motion, and ankle stability were evaluated. RESULTS AND CONCLUSION: (1) The American Orthopedic Foot and Ankle Society scores at 6 months postoperatively in both two groups were significantly higher than those at baseline, and the scores in the modified group were significantly higher than those in the traditional group (P < 0.05). (2) The Bohler angle, Gissane angle, and calcaneal width in the modified group were significantly improved compared with the traditional group at 1 week, 6 and 12 months postoperatively (P < 0.05). (3) Compared with the traditional group, the operation time, blood loss, and Visual Analogue Scale scores in the modified group were significantly improved (P < 0.05). (4) The incidence of complications in the modified group was significantly lower than that in the traditional group (P < 0.05). (5) These results manifest that compared with the traditional extended lateral "L-shape" incision with plate fixation for calcaneal fractures, the modified minimally invasive internal fixation with cannulated screws through tarsal sinus can significantly alleviate pain, and improve the range of motion and stability of the ankle joint.
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