纵行及跗骨窦入路治疗跟骨关节内骨折的比较研究

 目的 比较纵行及跗骨窦微创入路治疗跟骨关节内骨折的临床疗效。方法 回顾性分析2010年4月至2010年9月分别使用纵行及跗骨窦微创入路治疗并获随访的93例跟骨关节内骨折患者资料。按手术入路将患者分为两组：纵行微创入路组(A组)50例(51足)，男47例，女3例；平均年龄38.22岁；Sanders Ⅱ型27足，Ⅲ型18足，Ⅳ型6足；术前B?hler角平均-1.1°。跗骨窦微创入路组(B组)43例(45足)，男42例，女1例；平均年龄41.40岁；Sanders Ⅱ型23足，Ⅲ型17足，Ⅳ型5足；术前B?hler角平均2.6°。两组患者在年龄、性别、Sanders分型等方面无统计学差异。比较两组患者手术时间、并发症和美国足踝外科协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝与后足评分差异。结果 A、B两组患者随访时间分别为平均28.2个月和27.6个月。A组平均手术时间、切口相关并发症发生率及AOFAS踝与后足评分分别为40.78 min、3.92%(2/51)、85.96分，B组分别为60.67 min、8.89%(4/45)、88.60分。A组手术时间较B组更短，两组切口相关并发症发生率及术后AOFAS评分无差异。结论 纵行微创入路与跗骨窦微创入路治疗跟骨关节内骨折疗效无明显差异，但纵行微创入路手术时间更短、并发症少，是治疗跟骨骨折的良好选择。

Retrospective analysis of two minimally invasive approaches for displaced intra-articular calcaneal fractures:minimal invasive longitudinal approach and sinus tarsi approach

Objective To investigate the clinical results of two minimally invasive approaches for calcaneal fractures. Methods The data of 93 patients with displaced intra-articular calcaneal fractures was retrospectively analyzed who were treated from April 2010 to September 2010 in our trauma centre. The patients were divided into two groups according to different minimally invasive approaches. Group A consisted of 50 patients (51 feet) who were treated with the minimally invasive longitudinal approach, including 47 males and 3 females with an average age of 38.22 years. Type Sanders II included 27 feet, type III included 18 feet and type IV included 6 feet. B?hler angle was -1.1° on average before operation. Group B consisted of 43 patients (45 feet) who were treated with the sinus tarsi approach, including 42 males and 1 female with an average age of 41.40 years. Type Sanders II included 23 feet, type III included 17 feet and type IV included 5 feet. B?hler angle was 2.6° on average before operation. The difference was investigated between the two groups in their operation time, complications and the scores according to the ankle and hindfoot score system of American Orthopaedic Foot and Ankle Society (AOFAS). Results All patients were followed up in the two groups. The average time of follow-up was 28.2 months in Group A and 27.6 months in Group B. The mean operation time was 40.78 mins in Group A and 60.67 mins in Group B. The rate of complications in Group A was 3.92% (2/51), and 8.89% (4/45) in Group B. The mean AOFAS score was 85.96 in Group A and 88.60 in Group B. Conclusion No statistically significant difference was found between the minimally invasive longitudinal approach and the sinus tarsi approach in the effect of the treatment for the displaced intra-articular calcaneal fractures. However, the minimally invasive longitudinal approach could be a better choice for its shorter operation time and lower rate of complications than the sinus tarsi approach.