经跗骨窦小切口无头加压螺钉与外侧L形切口钢板固定治疗跟骨骨折的对比研究

Comparative study on medial wall and calcaneal alignment of calcaneal fractures by transtarsal small incision headless compression screw and lateral L-incision plate fixation

摘要:

目的 比较经跗骨窦小切口无头加压螺钉与外侧L形切口钢板固定对跟骨骨折内侧壁复位与跟骨力线纠正效果的影响。方法 选取2018年1月—2021年12月淮北矿工总医院收治的62例跟骨骨折患者，按随机数字表法分为研究组和对照组，每组31例。对照组给予外侧L形切口钢板固定治疗，研究组给予经跗骨窦小切口无头加压螺钉治疗。术后随访6个月。比较两组手术情况、视觉模拟评分法（VAS）及踝足关节功能，比较两组跟骨力线解剖学参数和跟骨骨折内侧壁复位情况，统计两组并发症发生情况。结果 研究组手术切口长度小于对照组（P <0.05），手术时间短于对照组（P <0.05），术中出血量少于对照组（P <0.05）。两组术前、术后3 d、术后7 d、术后1个月VAS评分比较：不同时间点的VAS评分有差异（P <0.05），研究组与对照组的VAS评分有差异（P <0.05），研究组与对照组的VAS评分变化趋势有差异（P <0.05）。两组术后6个月的踝足关节功能比较，差异无统计学意义（P >0.05）。两组术前、术后6个月的跟骨长度、跟骨宽度、跟骨高度、Bohler角、Gissane角、跟骨内翻角差值比较，差异无统计学意义（P >0.05）。两组术后6个月的跟骨骨折内侧壁复位良好率比较，差异无统计学意义（P >0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 经跗骨窦小切口无头加压螺钉与外侧L形切口钢板固定治疗跟骨骨折的疗效在踝足关节功能恢复、内侧壁复位、跟骨力线纠正方面无差异，但经跗骨窦小切口无头加压螺钉在减少手术创伤方面具有一定优势。

Abstract:

Objective To compare the effects of small incision headless compression screw and lateral L-incision plate fixation on calcaneal fracture medial wall reduction and calcaneal alignment correction.Methods From January 2018 to December 2021, 62 patients with calcaneal fractures admitted to our hospital were selected and divided into a study group and a control group by random number table method, with 31 cases in each. The control group was treated with plate fixation with lateral L incision, and the study group was treated with headless compression screw through the tarsal sinus small incision. The patients were followed up for 6 months. The operation conditions, pain, and ankle-foot joint function of the two groups were statistically analyzed. The anatomical parameters of the calcaneal line and the reduction of the medial wall were compared between the two groups. The incidence of complications in the two groups was counted.Results The length of incision, operation time, and intraoperative blood loss in the study group were lower than those in the control group (P < 0.05). The comparison of visual analogue scale (VAS) of pain between the two groups before operation, 3 days after operation, 7 days after operation, and 1 month after operation showed that there were differences in the VAS scores between different time points (P < 0.05), VAS scores of the study group and the control group were different (P < 0.05), and the change trend of the VAS score between the study group and the control group was different (P < 0.05). There was no significant difference in ankle and foot joint function between the two groups at 6 months after operation (P > 0.05). There was no significant difference in the difference of calcaneus length, calcaneus width, calcaneus height, Bohler angle, Gissane angle, and calcaneus varus angle between the two groups before operation and 6 months after operation (P > 0.05). There was no significant difference in the good reduction rate of medial wall of calcaneal fracture between the two groups 6 months after operation (P > 0.05). There was no significant difference in the incidence of total complications between the two groups (P > 0.05).Conclusion There was no difference in ankle-foot joint function recovery, medial wall reduction, and calcaneal alignment correction between calcaneal fractures treated with headless compression screws through the tarsal sinus small incision and lateral L-incision plate fixation. However, headless compression screws through the tarsal sinus small incision have certain advantages in reducing surgical trauma.