两种手术方式治疗跟骨关节内骨折的疗效比较

摘要

Objective To compare and evaluate the effects for the treatment of intra-articular calcaneal fractures via L-shaped lateral approach and improved sinus tarsi approach.Methods The 72 cases with intra-articular calcaneal fractures(76 feet)were treated,40 cases(group A,42 feet) were treated via traditional L-shaped lateral approach and 32 cases (group B,34 feet)via sinus tarsi approach.Operation time,blood loss,incision length,hospitalization time,VAS,the change of B(o)hler angle and Gissane angle,complications,and effects excellent-good rate of two groups were statistically compared.Results All patients were followed up for 24~40 months.Compared with group A,intraoperation blood loss,length of incision and duration of hospitalization was significantly shorter in group B(P<0.001).B(o)hler angle and Gissane angle were significantly restored after surgery(P<0.001),there was no statistical difference between two groups after operation(P>0.05).All patients′ fractures were healed without skin flap necrosis,B(o)hler angle loss and internal fixation exposure.Seven cases of complications occurred in group A,and 4 cases in group B,there was no statistically difference on the incidence of postoperative complications(P>0.05).At postoperative 2 years,the operative effect was excellent in 32 feet,good in 6 feet,fair in 4 feet in group A,which was excellent in 26 feet,good in 5 feet,fair in 3 feet in group B according to AOFAS standard.There was no statistical difference on the rate of the good-excellent between two groups,which was 90.48% in the former and 91.18% in the latter(P>0.05).Conclusions The L-shaped lateral approach for the treatment of intra-articular calcaneal fractures is believed to be as good as the sinus tarsi approach,both of them can obtain satisfactory outcomes,the latter shows the advantages of less trauma,less bleeding and shorter stays.%目的 比较跟骨外侧L形切口入路和经跗骨窦小切口入路治疗跟骨关节内骨折的临床疗效.方法 将72例跟骨关节内骨折患者(76足)按治疗方法分为A组(经跟骨外侧L形切口入路治疗,40例42足)和B组(经跗骨窦小切口入路治疗,32例34足).对比分析两组手术时间、术中失血量、切口长度、住院时间、疼痛VAS评分、治疗前后B(o)hler角及Gissane角变化、术后并发症、疗效优良率.结果 患者均获得随访,时间24~40个月.与A组比较,B组术中失血量少、切口长度短、住院时间短,差异均有统计学意义(P<0.001).术后B(o)hler角、Gissane角两组与术前比较差异均有统计学意义(P<0.001),两组之间比较差异无统计学意义(P>0.05).两组均未发生皮瓣坏死、B(o)hler角丢失及内置物外露.并发症:A组7例,B组4例,差异无统计学意义(P>0.05).术后24个月根据AOFAS踝-后足评分系统评定疗效:A组优32足,良6足,可4足,优良率90.48%;B组优26足,良5足,可3足,优良率91.18%;两组优良率比较差异无统计学意义(P>0.05).结论 跟骨外侧L形切口入路与经跗骨窦小切口入路治疗跟骨关节内骨折疗效均满意,但后者具有出血少、创伤小、住院时间短等优点.