摘要
背景：跟骨骨折是一种常见的复杂的足部骨折，多由高处坠落引起。移位及复杂的跟骨骨折仍需依靠手术治疗。但是术后伤口感染、疼痛等并发症发生率高，使得手术方式及入路仍存争议。本文就传统撬拨复位技术、经典外侧延长切口以及外侧小切口做一对比研究。目的：比较不同手术方式在跟骨关节内骨折治疗中的手术效果和优缺点。方法：回顾分析1990年2月至2010年9月，在我院行手术治疗的跟骨关节内骨折患者的病例资料。获得随访患者173例（195足）。其中采用撬拨复位技术44例，6例为双侧；标准外侧“L”形切口61例，9例为双侧；外侧小切口68例，7例为双侧。均为新鲜跟骨闭合性骨折，Sanders分型：Ⅱ型95例，Ⅲ型78例。患者年龄22~62岁，平均43岁。比较三组治疗期间的各项参数指标。结果：所有入组患者随访12~70个月，平均39个月。末次随访时，“L”形切口组和小切口组的B？hler角和Gissane角显著大于撬拨组（Q＜0.05），而“L”形切口组与小切口组无明显统计学差异（Q＞0.05）。撬拨组伤口未出现感染，“L”形切口组和小切口组的伤口感染率分别为22.86%和5.33%。撬拨组、“L”形切口组和小切口组的手术时间分别为（37±8.18）min、（83±12.83）min、（61±9.97）min，组间比较有显著统计学差异。撬拨组与小切口组的住院时间无明显统计学差异，分别为（7.36±0.61）d和（10.87±2.72）d，而“L”形切口组相对较长[（17.60±4.56）d]，与前两组有显著统计学差异。内固定材料费用上，三组之间有统计学差异：撬拨组（1780.32±40.21）元，“L”形切口组（33060.49±72.73）元，小切口组（21451.83±745.91）元。撬拨组、“L”形切口组和小切口组受伤至手术的时间分别为（103.68±6.20）h、（257.73±11.80）h、（176.40±9.19）h，组间比较有显著统计学差异。末次随访�
Background：Fractures of calcaneus are complex injuries with a high incidence in feet and usually the result of a fall from a great height. Surgical techniques are the preferred methods for displaced and comminuted fractures. Due to the rising rate of complications after operation, such as wound infection and pain, controversies remain regarding treatment options and sur-gical approaches. In this article, we attempted to investigate clinical effects by three different surgical treatments. Objective：To compare the complications and outcomes of three operations to determine the better approach for the treat-ment of calcaneal intraarticular fracture. Methods：Between 1990 and 2010, 175 patients were admitted for 195 calcaneal fracture, including 50 feet with percutane-ous reduction by leverage, 70 feet with L-shaped lateral approach and 75 feet with small sinus tarsi approach. All fractures were fresh closed fractures of calcaneus. There were 95 cases of SandersⅡand 78 cases of SandersⅢ. The mean age of the patients was 43 years （range, 22-62 years）. The measured parameters during treatment were compared between groups.＆amp;nbsp;Results： ALL the patients were followed up for 39 months on average （range, 12-70 months）. At the last follow-up, the B？hler and Gissane angles and AOFAS score of percutaneous reduction group were significantly lower than those of the oth-er two groups （Q〈0.05）, but there was no significant difference between L-shaped lateral approach group and small sinus tarsi approach group （Q〉0.05）. Wound infection occurred in 20 feet （10.25%）, including 16 feet in L-shaped lateral ap-proach group （22.86%） and 4 feet in small sinus tarsi approach group （5.33%）. There was no complication in percutaneous reduction group. There were significant differences in terms of operative time, costs of internal fixation and reoperation rate between groups. The hospital stay in L-shaped lateral approach group was longer than that in the other two groups. Conclusions：Smal
出处
《中国骨与关节外科》
2014年第4期280-284,304,共6页
Chinese Journal of Bone and Joint Surgery
关键词
撬拨复位技术
外侧“L”形切口
外侧小切口
跟骨骨折
疗效
Percutaneous reduction
L-shaped lateral approach
Small sinus tarsi approach
Calcaneus fracture
