| 李宁,鹿亮,罗文强,等.联合内侧切口与单纯扩大“L”型外侧入路治疗Squires Ⅳ型跟骨内侧突骨折的中期疗效对比.骨科,2025,16(6): 515-521. |
| 联合内侧切口与单纯扩大“L”型外侧入路治疗Squires Ⅳ型跟骨内侧突骨折的中期疗效对比 |
| A mid-term comparative study of combined medial approach versus extended lateral “L”-shaped approach for Squires type Ⅳ medial process of the calcaneal tuberosity fractures |
| 投稿时间：2025-05-06 |
| DOI：10.3969/j.issn.1674-8573.2025.06.007 |
| 中文关键词: 跟骨结节内侧突骨折 手术入路 对比研究 中期临床疗效 回顾性研究 |
| 英文关键词: Medial process of the calcaneal tuberosity fractures Surgical approach Comparative study Mid-term clinical outcomes Retrospective study |
| 基金项目:中国高校产学研创新基金-数字健康项目（2023GY034） |
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| 中文摘要: |
| 目的 比较联合内侧切口与单纯扩大“L”型外侧入路治疗Squires Ⅳ型跟骨结节内侧突骨折的中期临床疗效。方法 对2020年9月至2024年1月于我院治疗的67例Squires Ⅳ型跟骨内侧突骨折病人进行回顾性研究，根据手术方式的不同分为观察组（扩大“L”型外侧入路联合内侧切口，31例）和对照组（单纯扩大“L”型外侧入路，36例）。观察组男25例、女6例，年龄为（47.06±12.50）岁；对照组男30例、女6例，年龄为（45.75±14.06）岁。记录并比较两组病人手术时间、出血量、术后Böhler角、Gissane角、术后内侧突骨块移位距离，术后3、6、12个月疼痛视觉模拟量表（visual analogue scale，VAS）评分、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、Maryland足功能评分和并发症。结果 所有病人均完整随访至术后12个月。观察组手术时间长于对照组[（95.93±11.29）min vs. （76.28±12.13） min]，差异有统计学意义（P＜0.05）。两组术后出血量、Böhler角和Gissane角的差异均无统计学意义（P＞0.05）。观察组术后内侧突骨块移位距离明显低于对照组，差异有统计学意义（P＜0.05）。观察组出现1例浅表感染、1例皮肤坏死，对照组出现2例伤口愈合不良，经过换药好转。未发生骨髓炎、骨折延迟愈合或不愈合等并发症。观察组术后3、6、12个月VAS评分、AOFAS评分、Maryland评分与对照组比较，差异均无统计学意义（P＞0.05）。结论 对于Squires Ⅳ型跟骨内侧突骨折，中期随访发现外侧入路是否联合内侧切口复位固定内侧突骨块不显著影响足跟负重功能及预后。 |
| 英文摘要: |
| Objective To compare mid-term outcomes of combined medial approach versus extended lateral “L”-shaped approach for squires type Ⅳ medial process of the calcaneal tuberosity fractures. Methods A retrospective study was conducted on 67 patients with squires type Ⅳ medial process of the calcaneal tuberosity fractures treated in our hospital from September 2020 to January 2024. The patients were divided into observation group (31 cases, using the expanded “L” lateral approach combined with a medial incision) and control group (36 cases, using the simple expanded “L” lateral approach). The observation group included 25 males and 6 females, with age of (47.06±12.50) years, and the control group included 30 males and 6 females, with age of (45.75±14.06) years. The surgical duration, blood loss, postoperative Böhler angle, Gissane angle, displacement distance of the medial spur fragment, as well as the visual analog scale (VAS) scores for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Maryland Foot Score at 3, 6, and 12 months postoperatively, and complication rates were recorded and compared between the two groups. Results All patients were fully followed up until 12 months after surgery. The observation group had a longer surgical time than the control group [(95.93±11.29) min vs. (76.28±12.13) min], and the difference was statistically significant (P＜0.05). There was no statistically significant difference in postoperative bleeding volume, Böhler angle, and Gissane angle between the two groups (P＞0.05). The displacement distance of the medial protrusion bone block in the observation group after surgery was significantly shorter than that in the control group, and the difference was statistically significant (P＜0.05). The observation group had 1 case of superficial infection and 1 case of skin necrosis, while the control group had 2 cases of poor wound healing, which improved after dressing change. No complications such as osteomyelitis, delayed or non-union of fractures occurred. There was no statistically significant difference in VAS scores, AOFAS scores, and Maryland scores between the observation group and the control group at 3, 6, and 12 months after surgery (P＞0.05). Conclusion For squires type Ⅳ medial process of the calcaneal tuberosity fractures, combined medial approach did not significantly improve mid-term weight-bearing function or outcomes compared to lateral approach. |
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