外侧延长入路和跗骨窦入路联合内侧撑开技术治疗跟骨关节内骨折的比较
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摘要
目的比较经典的外侧延长入路与跗骨窦入路联合内侧支撑技术治疗跟骨关节内骨折的方法和临床疗效。方法回顾分析2014年4月至2017年11月采用切开复位内固定术治疗的100例伴有移位的跟骨关节内骨折患者的临床资料,采用跗骨窦入路联合内侧撑开技术患者40例(观察组),采用外侧延长入路患者60例(对照组)。所有患者均采用美国矫形足踝协会(AOFAS)踝-后足评分系统评价临床功能,采用X线片及CT检查测量B9hler角、Gissane角与跟骨内翻角评估骨折复位情况。结果所有患者在末次随访中均达到了骨性愈合,平均骨性愈合时间为10周。观察组患者术前等待时间、手术时间与对照组比较,差异无统计学意义(P均>0.05);观察组AOFAS踝-后足评分略高于对照组,但差异无统计学意义(P>0.05)。观察组切口并发症2例(5.0%),对照组13例(21.7%),观察组切口并发症发生率低于对照组,差异有统计学意义(χ2=5.229,P=0.022)。两组患者术后B9hler角、Gissane角与跟骨内翻角较术前改善,差异有统计学意义(P<0.05),但术后两组间比较仅有跟骨内翻角矫正值有统计学差异(P<0.05)。结论治疗跟骨关节内骨折采跗骨窦入路相对外侧延长入路可能会减少术后伤口并发症的发生率,且联合内侧牵引技术有助于矫正跟骨内翻畸形。
Objective To compare the clinical outcomes of classical lateral extension approach and tarsal sinus approach combined with medial distraction technique for intra-articular calcaneal fractures. Methods The clinical data of 100 patients with transposition of intra-articular fractures of the calcaneus treated with open reduction and internal fixation from April 2014 to November 2017 were reviewed in whom 40 patients underwent tarsal sinus approach combined with the medial distraction technique(observation group) and 60 patients received lateral extension approach(control group). The clinical functions were evaluated by American Orthopaedic Foot and Ankle Society(AOFAS) scoring system,and the fracture reduction was assessed by X-ray and CT examination of B9 hler angle,Gissane angle and calcaneal varusangle. Results All patients achieved bony union at the last follow-up. The average bone healing time was 10 weeks. There were no significant differences in preoperative waiting time and operation time between two groups(P > 0. 05). AOFAS ankle foot score in observation group was slightly higher than that in control group,but there was no statistical difference(P > 0. 05). There was no significant difference in the incidence of incision complication between observation group(2 cases) and control group(13 cases)(5. 0% vs 21. 7%,χ2= 5. 229,P = 0. 022). There were no difference in B9 hler angle,Gissane angle and calcaneal varusangle before operation(P > 0. 05). After operation,they significantly improved in both two groups(all P <0. 01),but there were no statistical differences between two groups except for correction value of calcaneal angle(P <0. 05) only. Conclusions Compared with lateral extension approach in the treatment of intra-articular calcaneal fractures,tarsal sinus approach could reduce the incidence of postoperative complications and contribute to correct the calcaneus varus deformity if combined with the medial distraction technique.
Objective To compare the clinical outcomes of classical lateral extension approach and tarsal sinus approach combined with medial distraction technique for intra-articular calcaneal fractures. Methods The clinical data of 100 patients with transposition of intra-articular fractures of the calcaneus treated with open reduction and internal fixation from April 2014 to November 2017 were reviewed in whom 40 patients underwent tarsal sinus approach combined with the medial distraction technique(observation group) and 60 patients received lateral extension approach(control group). The clinical functions were evaluated by American Orthopaedic Foot and Ankle Society(AOFAS) scoring system,and the fracture reduction was assessed by X-ray and CT examination of B9 hler angle,Gissane angle and calcaneal varusangle. Results All patients achieved bony union at the last follow-up. The average bone healing time was 10 weeks. There were no significant differences in preoperative waiting time and operation time between two groups(P > 0. 05). AOFAS ankle foot score in observation group was slightly higher than that in control group,but there was no statistical difference(P > 0. 05). There was no significant difference in the incidence of incision complication between observation group(2 cases) and control group(13 cases)(5. 0% vs 21. 7%,χ2= 5. 229,P = 0. 022). There were no difference in B9 hler angle,Gissane angle and calcaneal varusangle before operation(P > 0. 05). After operation,they significantly improved in both two groups(all P <0. 01),but there were no statistical differences between two groups except for correction value of calcaneal angle(P <0. 05) only. Conclusions Compared with lateral extension approach in the treatment of intra-articular calcaneal fractures,tarsal sinus approach could reduce the incidence of postoperative complications and contribute to correct the calcaneus varus deformity if combined with the medial distraction technique.
引文
[1]Basile A,Albo F,Via AG.Comparison between sinus tarsi approach and extensile lateral approach for treatment of closed displaced intraarticular calcaneal fractures:a multicenter prospective study[J].J Foot Ankle Surg,2016,55(3):513-521.
[2]Atmaca H,Memisoglu K,Baran T,et al.Treatment of calcaneal fractures with closed reduction and the Endobutton-assisted technique:short-term analysis[J].J Am Podiatr Med Assoc,2015,105(1):33.
[3]Griffin D,Parsons N,Shaw E,et al.Operative versus non-operative treatment for closed,displaced,intra-articular fractures of the calcaneus:randomised controlled trial[J].BMJ,2014,349:g4483.
[4]Jiang N,Lin QR,Diao XC,et al.Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base[J].Int Orthop,2012,36(8):1615-1622.
[5]De Boer AS,Van Lieshout EM,Den Hartog D,et al.Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures:a comparison among open,percutaneous,and nonoperative treatment[J].J Foot Ankle Surg,2015,54(3):298-305.
[6]Basile A.Subjectiveresultsaftersurgical treatment for displaced intraarticular calcaneal fractures[J].J Foot Ankle Surg,2012,51(2):182-186.
[7]Gotha HE,Zide JR.Current controversies in management of calcaneus fractures[J].Orthop Clin North Am,2017,48(1):91-103.
[8]Dhillon MS,Prabhakar S.Treatment of displaced intra-articular calcaneus fractures:a current concepts review[J].SICOT J,2017,3:59.
[9]Koodziejski P,Czarnocki,Wojdasiewicz P,et al.Intraarticular fractures of calcaneus-current concepts of treatment[J].Pol Orthop Traumatol,2014,79:102-111.
[10]Clement,Carter R,Lang,et al.SandersⅡ/Ⅲcalcaneus fractures in laborers:a cost-effectiveness analysis and call for effectiveness research[J].J Orthop Trauma,2017,31(6):299.
[11]Backes M,Schepers T,Beerekamp MS,et al.Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach[J].Int Orthop,2014,38(4):767.
[12]Backes M,Schep NW,Luitse JS,et al.The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures[J].Arch Orthop Trauma Surg,2015,135(8):1045.
[13]Kline AJ,Anderson RB,Davis WH,et al.Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures[J].Foot Ankle Int,2013,34(6):773-780.
[14]Khurana A,Dhillon MS,Prabhakar S,et al.Outcome evaluation of minimally invasive surgery versus extensile lateral approach in management of displaced intra-articular calcaneal fractures:a randomised control trial[J].Foot(Edinb),2017,31:23-30.
[15]De Boer AS,Van Lieshout EMM,Van't Land F,et al.Soft tissue complications and timing of surgery in patients with a tongue-type displaced intra-articular calcaneal fracture:an international retrospective cohort study[J].Injury,2018,49(2):425-429.
[16]Schepers T,Backes M,Dingemans SA,et al.Similar anatomical reduction and lower complication rates with the sinus tarsi approach compared with the extended lateral approach in displaced intra-articular calcaneal fractures[J].J Orthop Trauma,2017,31(6):293-298.
[17]Zeng Z,Yuan L,Zheng S,et al.Minimally invasive versus extensile lateral approach for sanders typeⅡandⅢcalcaneal fractures:a meta-analysis of randomized controlled trials[J].Int J Surg,2018,50:146-153.
[18]Yao H,Liang T,Xu Y,et al.Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base[J].J Orthop Surg Res,2017,12:43.
[19]张斌,杨晓斐,杨志刚,等.跗骨窦和纵行入路治疗移位关节内跟骨骨折的疗效及安全性比较[J].中国组织工程研究,2017,21(35):5661-5667.
[20]黄晟,沈鹏程,徐浩,等.改良经跗骨窦微创小切口空心钉内固定与传统外侧L形切口钢板内固定治疗跟骨骨折[J].中国组织工程研究,2017,21(35):5668-5672.
[21]花雷,沈红雷,许红俊,等.小切口微创解剖钢板联合加压螺栓与传统解剖钢板联合螺钉治疗跟骨关节内骨折的疗效比较[J].中国临床研究,2017,30(10):1324-1327.
[2]Atmaca H,Memisoglu K,Baran T,et al.Treatment of calcaneal fractures with closed reduction and the Endobutton-assisted technique:short-term analysis[J].J Am Podiatr Med Assoc,2015,105(1):33.
[3]Griffin D,Parsons N,Shaw E,et al.Operative versus non-operative treatment for closed,displaced,intra-articular fractures of the calcaneus:randomised controlled trial[J].BMJ,2014,349:g4483.
[4]Jiang N,Lin QR,Diao XC,et al.Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base[J].Int Orthop,2012,36(8):1615-1622.
[5]De Boer AS,Van Lieshout EM,Den Hartog D,et al.Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures:a comparison among open,percutaneous,and nonoperative treatment[J].J Foot Ankle Surg,2015,54(3):298-305.
[6]Basile A.Subjectiveresultsaftersurgical treatment for displaced intraarticular calcaneal fractures[J].J Foot Ankle Surg,2012,51(2):182-186.
[7]Gotha HE,Zide JR.Current controversies in management of calcaneus fractures[J].Orthop Clin North Am,2017,48(1):91-103.
[8]Dhillon MS,Prabhakar S.Treatment of displaced intra-articular calcaneus fractures:a current concepts review[J].SICOT J,2017,3:59.
[9]Koodziejski P,Czarnocki,Wojdasiewicz P,et al.Intraarticular fractures of calcaneus-current concepts of treatment[J].Pol Orthop Traumatol,2014,79:102-111.
[10]Clement,Carter R,Lang,et al.SandersⅡ/Ⅲcalcaneus fractures in laborers:a cost-effectiveness analysis and call for effectiveness research[J].J Orthop Trauma,2017,31(6):299.
[11]Backes M,Schepers T,Beerekamp MS,et al.Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach[J].Int Orthop,2014,38(4):767.
[12]Backes M,Schep NW,Luitse JS,et al.The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures[J].Arch Orthop Trauma Surg,2015,135(8):1045.
[13]Kline AJ,Anderson RB,Davis WH,et al.Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures[J].Foot Ankle Int,2013,34(6):773-780.
[14]Khurana A,Dhillon MS,Prabhakar S,et al.Outcome evaluation of minimally invasive surgery versus extensile lateral approach in management of displaced intra-articular calcaneal fractures:a randomised control trial[J].Foot(Edinb),2017,31:23-30.
[15]De Boer AS,Van Lieshout EMM,Van't Land F,et al.Soft tissue complications and timing of surgery in patients with a tongue-type displaced intra-articular calcaneal fracture:an international retrospective cohort study[J].Injury,2018,49(2):425-429.
[16]Schepers T,Backes M,Dingemans SA,et al.Similar anatomical reduction and lower complication rates with the sinus tarsi approach compared with the extended lateral approach in displaced intra-articular calcaneal fractures[J].J Orthop Trauma,2017,31(6):293-298.
[17]Zeng Z,Yuan L,Zheng S,et al.Minimally invasive versus extensile lateral approach for sanders typeⅡandⅢcalcaneal fractures:a meta-analysis of randomized controlled trials[J].Int J Surg,2018,50:146-153.
[18]Yao H,Liang T,Xu Y,et al.Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base[J].J Orthop Surg Res,2017,12:43.
[19]张斌,杨晓斐,杨志刚,等.跗骨窦和纵行入路治疗移位关节内跟骨骨折的疗效及安全性比较[J].中国组织工程研究,2017,21(35):5661-5667.
[20]黄晟,沈鹏程,徐浩,等.改良经跗骨窦微创小切口空心钉内固定与传统外侧L形切口钢板内固定治疗跟骨骨折[J].中国组织工程研究,2017,21(35):5668-5672.
[21]花雷,沈红雷,许红俊,等.小切口微创解剖钢板联合加压螺栓与传统解剖钢板联合螺钉治疗跟骨关节内骨折的疗效比较[J].中国临床研究,2017,30(10):1324-1327.
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