经跗骨窦切口钢板与螺钉固定治疗跟骨关节内骨折临床疗效比较

目的回顾性分析比较经跗骨窦切口钢板与螺钉圓定治疗跟骨关节内骨折的临床疗效。方法选取2018年1月至2020年1月江西中医药大学附属洪都中医院收治的60例跟骨关节内骨折患者作为研究对象, 根据术中内固定方式分为钢板组与螺钉组,钢板组30例共35足,螺钉组30例共33足。比较两组手术时间.并发症术中透视次数;影像学检查:包括术前、术后以及随访时Bohler角Gissane 角;术后6个月按美国足踝外科协会足与踝关节评:分(AOFAS评分)进行疗效评定:比较两组临床疗效。结果62例患者全部获得随访,随访时间12-18个月,中位15个月。两组并发症比较:钢板组有3例出现相关并发症,螺钉组有3例出现相关并发症。两组并发症发生率比较,差异无统计学意义(P>0.05)。两组手术时间,术中透视次数比较:螺钉组手术时间.术中透视次数少于钢板组,差异有极其显著的统计学意义(0.001)。 Bobler 角Gisane 角比较:钢板组和螺钉组的术后Bobler 角.Gisane角较术前明显改善,差异有极其显著的统计学意义(Po0.001)。术后6个月螺钉组与钢板组Bobler 角Gisane角比较,差异无统计学意义(P>0.05)。疗效评价:根据AOFAS评分,钢板组优良率为91.4%,螺钉组优良率为90.9%,网组比较差异无统计学意义(P>0.05)。结论经跗骨窦切口采用钢板固定或螺钉固定治疗跟骨关节内骨折属F微创手术,均能取得很好的临床疗效,与螺钉固定相比,钢板固定虽然手术时间更长,透视次数更多,但是对于维持复位更好,生物力学稳定性更强,所以对F粉碎的跟骨关节内骨折,更推荐使用钢板固定。

Comparison of clinical efficacies of intra - articular calcaneal fractures treated with plate and screw fixation through sinus tarsal incision

Objective To retrospectively analyze and compare the clinical efficacies of intra -articular calcaneal frac-tures with plate and screw fixation through sinus tarsi incision. Methods A total of 60 patients with calcaneal intra-ar-ticular fractures admitted to the Hongdu Hospital of Traditional Chinese Medicine from January 2018 to January 2020 were selected. According to the methods of intraoperative intermal fixation, they were divided into the plate group and the screw group, with 30 patients and 35 feet in the plate group and 30 patients and 33 feet in the screw group. The op-eration time, complications, and number of intraoperative fluoroscopies were compared between the two groups. Imaging examinations included Bohler angle and Gissane angle before operation, after operation and during follow-up. Eficacy was evaluated at 6 months after operation, using the American Orthopedic Foot and Ankle Score (AOFAS score) to com-pare the clinical efficacy between the two groups. Results All 60 patients were followed up for 12-18 months, with an average of 15 months. In terms of complications: there were 3 patients in the plate group with related complications,and 3 patients in the screw group with related complications. There was no significant difference in the incidence of complications between the two groups (P>0.05). In terms of operation time and number of intraoperative fluoroscopies: the operation time and number of intraoperative fluoroscopies in the screw group were less than those in the plate group, with extremely statistically significant differences (P<0.001). In termns of Bohler angle and Gissane angle: the postoperative Bohler angle and Gissane angle in the plate group and the screw group were significantly improved compared with those before operation, with extremely statistically significant differences (P<0.001). There were no significant differences in the Bohler angle and Gissane angle between the screw group and the plate group at 6 months after operation (P>0.05). In terms of efficacy: according to the AOFAS score, the excellent and good rate in the plate group was 91 .4%, and that in the screw group was 90.9%. The efficacy was very good in both groups, without statistically significant difference (P>0.05).Conclusion The treatment of intra- articular calcaneal fractures with plate or screw fixation through sinus tarsal incision is a minimally invasive surgery, which can achieve good clinical efficacy. Compared with screw fixation, plate fixation has a longer operation time and more fluoroscopies, but it is better for maintaining reduction with stronger biomechani-cal stability. Plate fixation is more recommended in the treatment of comminuted intra-articular calcaneal fractures.