摘要 目的分析比较跗骨窦入路与广泛外侧入路治疗跟骨骨折的临床疗效。方法回顾性分析104例跟骨骨折患者的临床资料，按不同手术入路进行分组：观察组54例，采用跗骨窦入路克氏针内固定术治疗；对照组50例，行广泛外侧入路钢板内固定术治疗；比较两组患者的手术时间、术中出血量、术后住院天数、切口愈合时间、并发症发生情况、手术前后的跟骨高度、宽度、Gissane角、Bhler角、术后恢复情况及疗效优良率，以美国足踝外科协会(American orthopedic foot and ankle society, AOFAS)踝-后足评分、Maryland评分评价术后疗效。结果观察组手术时间、切口愈合时间短于对照组，术中出血量、术后住院天数少于对照组，切口愈合率明显高于对照组（98.1% VS 88.0%），并发症率低于对照组（3.7% VS 20.0%），差异均有统计学意义(P＜0.05)。两组手术后跟骨高度、宽度、Gissane角、Bhler角均较术前明显改善（P<0.05），但组间比较均无统计学差异（P>0.05）。术后两组AOFAS踝-后足评分、Maryland评分比较，差异均无统计学意义(P＞0.05)。观察组疗效优良率为88.9%，高于对照组的72.0%，差异有统计学意义（P＜0.05)。结论采用跗骨窦入路行跟骨骨折内固定术的临床疗效优于广泛外侧入路，具有创伤小、术后康复快、并发症发生少等优势，值得临床推广应用。
Abstract: ObjectiveTo compare the clinical effect of internal fixation by tarsal sinus approach and extensive lateral approach for treatment of calcaneal fractures.MethodsThe clinical data of 104 cases with calcaneal fractures were retrospectively analyzed. According to different surgical approaches, 54 cases performed internal fixation with Kirschner wire by tarsal sinus approach as the observation group, and 50 cases received internal fixation with plate by extensive lateral approach as the control group.ResultsCompare to the control group, the operation time and incision healing time were shorter, the intraoperative blood loss and postoperative hospital stays was less, the incision healing rate was higher and the complication rate was lower in the observation group, and the differences were statistically between two groups (P<0.05). The height and width of calcaneus, the Gissane angle and Bhler angle were improved remarkable after the surgery than those before the surgery (P<0.05), but there were no statistical differences in them between the two groups (P>0.05). No statistical difference was found in the postoperative AOFAS anklehind foot score and Maryland score between the two groups (P>0.05). The excellent and good rate of the observation group was 88.9%, which was significantly higher than 72.0% of the control group (P<0.05).ConclusionThe curative effect of internal fixation via tarsal sinus approach has the advantages of minitrauma, rapid postoperative rehabilitation and less complication, and it is superior to that of extensive lateral approach for calcaneal fractures.
杨磊，王岩石. 跗骨窦入路与广泛外侧入路内固定术治疗跟骨骨折临床分析[J]. 中国现代手术学杂志, 2017, 21(5): 366-370.
YANG Lei, WANG Yanshi. Comparison Analysis on the Internal Fixation by Tarsal Sinus Approach and Extensive Lateral Approach for Calcaneal Fractures. Chinese Journal of Modern Operative Surgery, 2017, 21(5): 366-370.
Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intraarticular calcaneal fracture［J］. Foot Ankle Int, 2013, 34(6):773780. doi: 10.1177/1071100713477607.
Jacquot F, Letellier T, Atchabahian A, et al. Balloon reduction and cement fixation in calcaneal articular fractures: a fiveyear experience［J］. Int Orthop, 2013, 37(5):905910. doi: 10.1007/s002640131865x.
Abdelazeem A, Khedr A, Abousayed M, et al. Management of displaced intraarticular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique［J］. Int Orthop, 2014, 38(3):601606. doi: 10.1007/s002640132203z.
Jonas SC, Young AF, Curwen CH, et al. Functional outcome following tibiotalarcalcaneal nailing for unstable osteoporotic ankle fractures［J］. Injury, 2013, 44(7):994997. doi: 10.1016/j.injury.2012.11.008.
Fan WL, Sun HZ, Wu SY, et al. Subtalar distraction osteogenesis for posttraumatic arthritis following intraarticular calcaneal fractures［J］. Foot Ankle Int, 2013, 34(3):398402. doi: 10.1177/1071100712472039.
Wang ZJ, Huang XL, Chu YC, et al. Applied anatomy of the calcaneocuboid articular surface for internal fixation of calcaneal fractures［J］. Injury, 2013, 44(11):14281430. doi: 10.1016/j.injury.2012.08.023.
2017, Vol. 21 
