跗骨窦切口辅助Ilizarov技术与切开复位内固定治疗SandersⅢ、Ⅳ型跟骨骨折的疗效比较

目的:探讨跗骨窦切口辅助Ilizarov技术治疗SandersⅢ、Ⅳ型跟骨骨折的疗效。方法:回顾性分析2013年6月～2019年12月治疗的40例(45足)SandersⅢ、Ⅳ型跟骨骨折患者资料,微创外架组16例(17足)采用跗骨窦切口辅助Ilizarov技术治疗,切开钢板组24例(28足)采用经外侧"L"形切口切开复位钢板内固定术治疗。对比两组的手术相关时间及出血量、手术前后的影像学变化和术后的患足功能、生活质量、疼痛情况。结果:至末次随访时,所有病例达到骨性愈合,微创外架组平均愈合时间(11.77±3.13)周,切开钢板组平均愈合时间(12.02±2.97)周,差异无统计学意义(P>0.05)。术前两组患者的健侧、患侧影像学测量结果对比,差异无统计学意义(P>0.05)。术后切开钢板组Bohler角、Gissane角优于微创外架组,差异有统计学意义(P<0.05)。微创外架组轴位角、跟骨长度、足跟宽度优于切开钢板组,差异有统计学意义(P<0.05)。微创外架组等待手术时间、止血带时间、手术时间、出血量均比切开钢板组少,差异有统计学意义(P<0.05)。微创外架组美国足踝外科协会踝-后足评分、疼痛评分、并发症发生率与切开钢板组比较,差异无统计学意义(P>0.05)。微创外架组健康调查简表SF-36评分较切开钢板组高,差异有统计学意义(P<0.05)。结论:跗骨窦切口辅助Ilizarov技术治疗SandersⅢ、Ⅳ型跟骨骨折可取得与切开复位内固定相似的疗效,是治疗难复性跟骨关节内骨折的一种良好选择。

Comparison of Ilizarov technique assisted by tarsal sinus incision and ORIF in the treatment of Sanders type III and IV calcaneal fracturesYu Lanwei,Zhang Zhuhui,Qiu Huaji,Wang Qingyu,Chen Yan,Li Lianghua,Han Dawei

Objective To investigate the clinical effect of Ilizarov technique assisted by tarsal sinus incision in the treatment of Sanders type III and IV calcaneal fractures. Methods From June 2013 to December 2019, 40 patients (45 feet) with Sanders type III and IV calcaneal fractures were treated, including 34 males and 6 females. 17 feet of 16 cases were treated with Ilizarov technique assisted by tarsal sinus incision (minimally invasive external fixation group), and 28 feet of 24 cases were treated with open reduction and plate fixation through lateral "L" incision (open plate group). The general situation of operation, imaging changes before and after operation, and postoperative foot function and pain were compared between the two groups. Results At the last follow-up, all cases achieved bone healing: the average healing time of minimally invasive external fixation group was (11.77 ± 3.13) weeks; the average healing time of open plate group was (12.02 ± 2.97) weeks, there was no significant difference. There was no significant difference in the imaging measurement results of the affected side between the two groups before operation. The waiting time, tourniquet time, operation time and blood loss of minimally invasive external fixator group were shorter than those of open plate group (less), with statistical difference. There was no significant difference in the anatomical parameters and functional scores of calcaneus between the two groups. However, the AOFAS score and SF-36 score of the two groups were higher than that of the minimally invasive external fixator group. Conclusion The treatment of Sanders type III and IV calcaneal fractures with Ilizarov assisted by tarsal sinus incision can achieve a similar effect with open reduction and internal fixation. It is a good choice for the treatment of intra-articular fractures of the calcaneus.