经跗骨窦入路微创接骨板联合埋头螺钉治疗跟骨骨折
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1.蚌埠医学院附属连云港市第二人民医院;2.苏州大学附属第一医院

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蚌埠医学院自然科学重点项目(课题编号:BYKY2019249ZD)


Clinical observation on the treatment of calcaneal fractures with minimally invasive locking plate combined with countersunk screw via tarsal sinus approach
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1.Lianyungang Second People'2.'3.s Hospital Affiliated to Bengbu Medical College;4.The First Affiliated Hospital of Soochow University

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    摘要:

    目的:比较跗骨窦入路联合埋头螺钉及微创锁定接骨板与外侧L形入路联合跟骨解剖锁定接骨板治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效。方法:回顾性分析2018年7月至2021年8月收入院的Sanders Ⅱ、Ⅲ型跟骨骨折患者40例44足,根据治疗方法不同,分为跗骨窦组(跗骨窦入路结合埋头螺钉及微创锁定接骨板)21足和L形组(传统外侧L形入路结合跟骨解剖锁定接骨板)23足。结果:跗骨窦组手术前准备时间短于L形组,组间差异有统计学意义(P<0.05);跗骨窦组手术操作时间短于L形组,组间差异有统计学意义(P<0.05);跗骨窦组术中出血量少于L形组,组间差异有统计学意义(P<0.05);跗骨窦组切口长度短于L形组,组间差异有统计学意义(P<0.05);跗骨窦组术后第一天VAS评分小于L形组,组间差异有统计学意义(P<0.05);跗骨窦组有两足发生皮缘坏死,经换药后愈合,L形组有1足发生切口感染,3足发生皮缘坏死,3足发生皮瓣坏死,1足发生距下关节炎。结论:经跗骨窦入路微创锁定接骨板联合埋头螺钉治疗Sanders Ⅱ、Ⅲ型跟骨骨折具有术前准备时间短、手术时间短、术中出血量少、切口小、并发症少等优点,临床疗效好,值得临床推广。

    Abstract:

    Purpose: To compare the clinical efficacy of tarsal sinus approach combined with counterhead screw and minimally invasive locking plate and lateral L-shaped approach combined with calcaneal anatomical locking plate in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures. Methods: A retrospective analysis was performed on 44 feet of 40 patients with Sanders type Ⅱ and Ⅲ calcaneal fractures admitted to our hospital from July 2018 to August 2021. According to different treatment methods, they were divided into group A (tarsal sinus approach combined with counterhead screw and minimally invasive locking plate) with 21 feet and group B (traditional lateral L-shaped approach combined with anatomical locking plate of calcaneal bone) with 23 feet. Results: The time of preoperative preparation in group A was shorter than that in group B, and the difference was statistically significant (P<0.05); The operative time of group A was shorter than that of group B, and the difference was statistically significant (P<0.05); The amount of intraoperative blood loss in group A was less than that in group B, and the difference was statistically significant (P<0.05); The incision length in group A was shorter than that in group B, and the difference was statistically significant (P<0.05); VAS score of group A on the first postoperative day was lower than that of group B, and the difference between groups was statistically significant (P<0.05); Skin edge necrosis occurred in two feet in group A and healed after dressing change, while incision infection occurred in one foot, skin edge necrosis occurred in three feet, flap necrosis occurred in three feet, and subtalar arthritis occurred in one foot in group B.Conclusions: The minimally invasive locking bone plate combined with countersunk screw through the tarsal sinus approach for the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of short preoperative preparation time, short operation time, less intraoperative blood loss, small incision and fewer complications, etc., also has good clinical efficacy and worthy of clinical promotion.

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  • 收稿日期:2022-04-28
  • 最后修改日期:2022-10-20
  • 录用日期:2022-12-08
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