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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 507 -511. doi: 10.3877/cma.j.issn.1674-134X.2022.04.021

临床经验

微创双切口与外侧L形切口治疗跟骨骨折的疗效对比
邹建平1, 李惠锡1, 陈锦明1, 刘凯骅1, 陈进宇1, 林军华1,†()   
  1. 1. 529100　江门市新会区人民医院骨科
  • 收稿日期:2021-01-26 出版日期:2022-08-01
  • 通信作者: 林军华

Comparison of curative effects between minimally invasive double incision and lateral L-shaped incision in treatment of calcaneal fracture

Jianping Zou1, Huixi Li1, Jinming Chen1, Kaihua Liu1, Jinyu Chen1, Junhua Lin1,†()   

  1. 1. Department of Orthopedics, Xinhui People's Hospital, Jiangmen 529100, China
  • Received:2021-01-26 Published:2022-08-01
  • Corresponding author: Junhua Lin
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引用本文：

邹建平, 李惠锡, 陈锦明, 刘凯骅, 陈进宇, 林军华. 微创双切口与外侧L形切口治疗跟骨骨折的疗效对比[J]. 中华关节外科杂志(电子版), 2022, 16(04): 507-511.

Jianping Zou, Huixi Li, Jinming Chen, Kaihua Liu, Jinyu Chen, Junhua Lin. Comparison of curative effects between minimally invasive double incision and lateral L-shaped incision in treatment of calcaneal fracture[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(04): 507-511.

目的

对比分析经微创双切口与外侧L形切口入路内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效。

方法

回顾性分析2014年1月至2019年6月在江门市新会区人民医院行切开复位钢板内固定治疗的60例Sanders Ⅱ、Ⅲ型跟骨骨折，根据切口入路不同分为经微创双切口组(微创组)和经外侧L形切口组(常规组)，每组各30例。采用t检验对比分析两组患者术前等待时间、手术时间、术中出血量、骨折愈合时间、末次随访时B?hler角、Gissane角和美国足踝外科协会(AOFAS)评分，采用卡方检验对比分析受伤原因及分型，伤口并发症的对比采用Fisher精确检验。

结果

两组所有患者均获得随访，平均(13±3)月。术前等待时间微创组短于常规组(t＝－8.152，P<0.05)；手术时间微创组短于常规组(t＝－8.473，P<0.05)；术中出血量微创组少于常规组(t＝－4.582，P<0.05)。微创组术后出现3例(10.0%)切口并发症，低于常规组12例(40.0%)(P＝0.015)。而在骨折愈合时间及末次随访时B?hler角、Gissane角、AOFAS评分方面，两组间差异无统计学意义(均为P>0.05)。

结论

微创双切口入路治疗Sanders Ⅱ、Ⅲ型跟骨骨折，手术时间短，术中出血少，术后并发症发生率低，值得临床推广。

关键词: 跟骨, 关节内骨折, 内固定器, 最小侵入性外科手术
Objective

To compare the clinical outcomes of minimally invasive double incision approach and external L-shaped approach with internal fixation for treatment of Sanders typeⅡand Ⅲ calcaneal fractures.

Methods

According to different incision approaches, sixty patients with calcaneal fractures of Sanders typeⅡand Ⅲ who were treated in Xinhui People’s Hospital between January 2014 and June 2019 were enrolled and divided into the minimally invasive group(minimally invasive double incision approach) and routine group(external L-shaped approach), 30 cases in each group. The t test was used to analyze the preoperative time, operation time, blood loss, fracture healing time, B?hler angle, Gissane angle and American Orthopedic Foot and Ankle Society (AOFAS) score of the two groups; chi-square test was used to analyze the types and the causes; Fisher exact test was used to compare the wound complications.

Results

All the patients were followed up for an average of (13±3) months. The preoperative time of minimally invasive group was shorter than that of routine group (t=-8.152, P<0.05); the operation time in the minimally invasive group was shorter than that in the conventional group (t=-8.473, P<0.05); the blood loss in the minimally invasive group was less than that in the conventional group (t=-4.582, P<0.05). Incision complications occurred in three cases (10.0%) in the minimally invasive group, which was lower than that in 12 cases (40.0%) in the conventional group (P=0.015). There was no statistically significant difference between the two groups in terms of fracture healing time, B?hler angle, Gissane angle or AOFAS score (all P>0.05).

Conclusion

The minimally invasive double incision approach with internal fixation for treatment of Sanders typeⅡand Ⅲ ca1canea1 fractures has lesser operation time, less intraoperative blood loss and fewer wound complications.

Key words: Calcaneus, Intra-articular fractures, Internal fixators, Minimally invasive surgical procedures
表1 一般资料对比
组别 例数 侧别(例) 性别(例) 年龄[岁，(±s)] 受伤原因(例) Sanders分型(例)
单侧 双侧 男 女 A B C Ⅱ Ⅲ
微创组 30 25 5 24 6 43±11 22 7 1 26 9
常规组 30 26 4 25 5 44±9 23 5 2 23 11
统计值   χ2<0.001 χ2＝0.111 t＝－0.529 χ2＝0.786 χ2＝0.369
P值   >0.05 >0.05 >0.05 >0.05 >0.05
表2 围手术期数据对比
组别 例数 术前等待时间[d，(±s)] 手术时间[min，(±s)] 术中出血量[ml，(±s)] 并发症(例)
微创组 30 4.8±1.3 56.7±7.3 19.3±7.5 3
常规组 30 9.3±2.7 76.7±10.7 30.7±11.3 12
t值   －8.152 －8.473 －4.582  
P值   <0.001 <0.001 <0.001 0.015*
表3 末次随访时影像学测量及功能评分对比(±s)
组别 足例数 Böhler角(°) Gissane角(°) AOFAS评分(分) 骨折愈合时间(周)
微创组 35 26.1±5.2 122.9±6.6 80.8±5.8 11.8±1.4
常规组 34 24.9±5.3 123.4±8.1 79.9±4.3 12.0±2.0
t值   0.932 －0.296 0.768 －0.485
P值   >0.05 >0.05 >0.05 >0.05
图1 典型病例手术前后情况。图A为术前左侧跟骨三维CT，示左跟骨粉碎性骨折；图B为术前切口标识；图C为术后切口外观；图D为术后2周拆线时，示伤口愈合良好；图E术后左踝侧位X线片，示内固定位置好，B?hler角、Gissane角恢复良好；图F~G为术后1年随访情况，示踝关节屈伸活动良好
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