| 吴佳俊,沈超,周小小,等.距下关节镜辅助下经跗骨窦入路治疗Sanders Ⅱ型跟骨骨折.骨科,2022,13(5): 409-413. |
| 距下关节镜辅助下经跗骨窦入路治疗Sanders Ⅱ型跟骨骨折 |
| Subtalar Arthroscopy Assisted via Tarsal Sinus Approach for Sanders Type Ⅱ Calcaneal Fracture |
| 投稿时间：2022-05-13 |
| DOI：10.3969/j.issn.1674-8573.2022.05.006 |
| 中文关键词: 跟骨骨折 跗骨窦入路 距下关节镜 临床疗效 |
| 英文关键词: Calcaneal fracture Tarsal sinus approach Subtalar arthroscopy Clinical efficac |
| 基金项目:浦东新区卫健委临床特色学科项目（PWYts2021-03）；上海市卫生健康委员会科研课题基金（20204Y0478）；上海市卫生健康委先进适宜技术推广项目基金（2019SY069） |
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| 中文摘要: |
| 目的 探讨“干性”距下关节镜辅助下经跗骨窦入路手术治疗Sanders Ⅱ型跟骨关节内骨折的疗效。方法 回顾性分析2015年12月至2020年12月在我院采用经跗骨窦入路治疗的47例Sanders Ⅱ型跟骨关节内骨折病人，根据术中复位评估方式，分为单纯移动“C”型臂X线机透视组（简称透视组，30例）、联合“干性”距下关节镜组（简称关节镜组，17例）。记录两组病人一般资料、手术时间、术中出血量、术前及术后Böhler角和Gissane角，依据术后CT评估跟骨后关节面复位效果，比较两组末次随访美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足功能评分系统评分。结果 两组病人手术均顺利完成，手术时间与术中出血量的差异均无统计学意义（P＞0.05）。所有病人均获得随访，两组随访时间[（23.6±9.3）个月vs.（20.2±7.9）个月]比较，差异无统计学意义（P＞0.05）。两组术后Böhler角、Gissane角与术前比较，差异均有统计学意义（P＜0.001）。两组术后Böhler角和Gissane角组间比较，差异均无统计学意义（P＞0.05）。术后CT评估关节面复位情况，透视组复位优19例，良11例；关节镜组复位优16例，良1例，关节镜组复位情况优于透视（χ2=3.911，P=0.048）。末次随访时比较，关节镜组AOFAS评分[（87.3±6.4）分]优于透视组[（81.8±7.2）分]，差异有统计学意义（P=0.002）。结论 “干性”距下关节镜辅助下经跗骨窦入路可提高Sanders Ⅱ型跟骨关节内骨折复位效果，利于跟骨骨折术后的功能恢复，具有较好的临床应用价值。 |
| 英文摘要: |
| Objective To discuss the curative effectiveness of “dry subtalar arthroscopy” in the treatment of Sanders Ⅱ intra-articular calcaneal fracture via tarsal sinus approach. Methods From December 2015 to December 2020, 47 cases of Sanders Ⅱ intra-articular calcaneal fractures treated by tarsal sinus approach in our hospital were retrospectively analyzed. According to the evaluation methods of intraoperative reduction, they were divided into two groups: X-ray fluoroscopy group (30 cases) and arthroscopy group (17 cases). The general information, operation time, intraoperative blood loss, Böhler angle and Gissane angle before and after operation in the two groups were recorded respectively, the reduction effect of posterior calcaneal articular surface after operation was evaluated by CT, and the American Orthopaedic Foot and Ankle Society (AOFAS) function score at the last follow-up was compared. Results The operation of both groups was successful, and there was no significant difference in the operation time between two groups [(53.4±15.3) min vs. (62.5±14.2 min)] and the intraoperative blood loss [(33.5±9.3) mL vs. 39.2±8.6 mL] (P＞0.05). All patients got the above follow-up, and there was no statistically significant difference between the fluoroscopy group (23.6±9.3 months) and the arthroscopy group (20.2±7.9 months) (P＞0.05). The in-group comparison showed that there were significant differences in Böhler angle and Gissane angle in the two groups before and after operation (P＜0.001). There was no significant difference in Böhler angle and Gissane angle between the two groups after operation (P＞0.05). In fluoroscopy group, the reduction was excellent in 19 cases and good in 11 cases. In arthroscopic group, the reduction was excellent in 16 cases and good in 1 case. The reduction of arthroscopic group was better than that of fluoroscopic group (χ2=3.911, P=0.048). At the last follow-up, the AOFAS score in arthroscopy group (87.3±6.4) was better than that in fluoroscopy group (81.8±7.2) (P=0.002). Conclusion The tarsal sinus approach assisted by “dry subtalar arthroscopy” can improve the reduction effect of Sanders Ⅱ intra-articular calcaneal fracture, and is beneficial to the functional recovery after calcaneal fracture surgery. |
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