跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折的并发症及影响因素分析

  目的  研究跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折的并发症及影响因素。  方法  选取2018年7月—2020年6月浙江大学医学院附属第二医院创伤骨科收治的84例跟骨骨折患者,并对其临床资料进行回顾性研究,根据不同术式将其分为对照组和跗骨窦组,每组各42例。对照组行外侧“L”形切口内固定手术,跗骨窦组行跗骨窦切口微创钢板及空心钉轴向内固定手术,比较切口长度、出血量、消肿时间、愈合拆线时间、Bohler角、Gissane角、后踝后足功能改善率、并发症发生率。采用logistic回归分析研究术后并发症的影响因素。  结果  跗骨窦组切口长度、出血量、消肿时间、愈合拆线时间短于对照组,差异有统计学意义(均P＜0.05)。Bohler角跗骨窦组高于对照组,差异有统计学意义(P＜0.05), 而2组Gissane角差异无统计学意义(P＞0.05)。跗骨窦组总改善率为90.5%(38/42),高于对照组61.9%的改善率(26/42, P＜0.05)。跗骨窦组并发症发生率为28.6%(12/42),低于对照组50.0%(21/42)的发生率,差异有统计学意义(P＜0.05)。回归分析显示手术方式、消肿时间、愈合拆线时间、Bohler角、年龄、功能改善是影响术后并发症发生的因素。  结论  跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折优于L形切口,而手术方式、消肿时间、愈合拆线时间、Bohler角、年龄、功能改善等因素影响手术预后效果。 

Analysis of complications and influencing factors of sinus tarsal incision mini-plate combined with hollow nail internal fixation for treatment of calcaneal fractures

  Objective  To explore the complications and influencing factors of calcaneal fractures treated with tarsal sinus incision microplate combined with cannulated screw internal fixation.  Methods  From July 2018 to June 2020, 84 patients with calcaneal fractures admitted to the Department of Traumatology and Orthopaedics of the Second Affiliated Hospital of Zhejiang University School of Medicine were selected, and their clinical data were retrospectively studied. They were divided into control group and tarsal sinus group in accordance with different surgical procedure, with 42 cases in each group. The control group underwent lateral L-shaped incision internal fixation and the tarsal sinus group underwent minimally invasive tarsal sinus incision plate and cannulated screw axial internal fixation. The Bohler angle, Gissane angle, improvement rate of hind ankle and hindfoot function and complication rate were determined. Logistic regression was used to analyse the influencing factors of postoperative complications.  Results  The length of incision, the amount of blood loss, the time for detumescence and the time for healing and removing sutures in the sinus tarsi group were shorter than those in the control group, the differences were statistically significant (all P < 0.05). The Bohler angle was higher in the sinus tarsi group than in the control group and the difference was statistically significant (P < 0.05). On the contrary, no significant difference was found in the Gissane angle between the two groups (P>0.05). The total improvement rate of the sinus tarsi group was 90.5% (38/42), which was higher than that of the control group at 61.9% (26/42), and the difference was statistically significant (P < 0.05). The incidence of complications in the sinus tarsi group (28.6%, 12/42) was lower than that in the control group (50.0%, 21/42) and the difference was statistically significant (P < 0.05). Regression analysis showed that operation method, swelling time, suture removal time, Bohler angle, age, and functional improvement were independent risk factors for postoperative complications.  Conclusion  Tarsal sinus incision microplate combined with cannulated screw internal fixation is better than L-shaped incision in the treatment of calcaneal fractures. Factors such as surgical method, detumescence time, healing and suture removal time, Bohler angle, age and functional improvement affect the prognosis of surgery.