目的 观察距下关节镜结合术中 X 线透视微创复位螺钉内固定治疗跟骨 Sanders Ⅱ、Ⅲ 型骨折的效果.方法 回顾分析 2019 年 1 月至 2022 年 4 月,本院足踝外科收治的 128 例跟骨 Sanders Ⅱ、Ⅲ 型骨折患者.根据手术方式分为关节镜组(距下关节镜辅助结合术中 X 线透视微创复位螺钉内固定)58 例,对照组(传统 L 形切口行切开复位钢板内固定术)70 例.比较两组切口长度、出血量、伤口并发症、手术时间、骨折愈合时间、术后 1 年美国矫形外科足踝协会(American Orthopedic Foot and Ankle Association,AOFAS)评分,疼痛视觉模拟评分(visual analog score,VAS).结果 切口长度:关节镜组(3.05±0.91)cm 小于对照组(11.63±1.64)cm,差异有统计学意义(P<0.05);出血量:关节镜组(20.69±7.34)ml 小于对照组(227.07±92.37)ml,差异有统计学意义(P<0.05);手术时间:关节镜组(99.31±14.70)min 长于对照组(63.29±8.55)min,差异有统计学意义(P<0.05);切口并发症发生率:关节镜组(5.97%)小于对照组(20.0%),差异有统计学意义(P<0.05);骨折愈合时间:关节镜组(8.72±1.10)周短于对照组(11.06±1.33)周,差异有统计学意义(P<0.05);术后 1 年 AOFAS 评分:关节镜组(89.07±4.045)分,高于对照组(81.09±12.32)分,差异有统计学意义(P<0.05);术后 1 年 VAS 评分:关节镜组(1.74±1.26)分,低于对照组(2.91±1.29)分,差异有统计学意义(P<0.05).结论 采用距下关节镜结合术中 X 线透视微创复位螺钉内固定治疗 SandersⅡ、Ⅲ 型跟骨骨折具有切口小,出血量及伤口并发症少,愈合快等优点,可达到良好的复位固定,治疗效果满意.
Objective To observe the effect of subtalar arthroscope combined with fluoroscopy in the minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Methods A total of 128 patients with SandersⅡ and Ⅲ calcaneal fractures admitted to Department of Foot and Ankle,Tangshan The Second Hospital from Jan.2019 to Apr.2022 were selected as research objects.The patients were divided into two groups according to the operation performed.Arthroscopy group:58 cases,subtalar arthroscope assisted with the internal fixation of the cannulation with minimally incision.Control group:70 cases,internal fixation of the bone plate with conventional lateral L-shaped incision.Surgical incision length,intraoperative blood loss,wound complications,operation time,fracture healing time and AOFAS score and pain VAS score one year postoperatively were compared between the two groups.Results The surgical incision of the arthroscopy group(3.05±0.91)cm was shorter than that of the control group(11.63±1.64)cm,and the differences were statistically significant(P<0.05).The blood loss of the arthroscopy group(20.69±7.34)ml was less than that of the control group(227.07±92.37)ml,and the differences were statistically significant(P<0.05).The operation time of the arthroscopy group(99.31±14.70)min was longer than that of the control group(63.29±8.55)min,and the differences were statistically significant(P<0.05).The fracture healing time of the arthroscopic group(8.72±1.10)w was less than that of the control group(11.06±1.33)w,and the differences were statistically significant(P<0.05).The AOFAS score of the arthroscopic group at 1 year follow-up(89.07±4.045)was higher than that of the control group(81.09±12.32),and the differences were statistically significant(P<0.05).The VAS score of the arthroscopic group at 1 year follow-up(1.74±1.26)was higher than that of the control group(2.91±1.29),and the differences were statistically significant(P<0.05).Conclusions Subtalar arthroscope combined with fluoroscopy in the minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures has good effects with the advantages of small incision,less bleeding and wound complications and rapid recovery while ensuring reliable fixation and satisfactory reduction.