不同入路方式治疗跟骨关节内骨折的效果及对患者应激水平的影响

doi:10.3969/j.issn.1009-976X.2021.06.015

摘要/Abstract

摘要： 目的探究不同入路方式治疗跟骨关节内骨折的效果及对患者应激水平的影响。方法选取本院于2016年10月至2019年12月收治的跟骨关节内骨折患者108例,依据入路方式的不同将其分为观察组（56例）和对照组（52例）,观察组采取跗骨窦小切口入路,对照组行跟骨外侧L型切口入路。对比分析两组患者的围术期情况,采用美国足踝协会足部功能评分系统（AOFAS）评价患者术后6个月功能恢复情况,术后6个月行影像学检查,对比两组术前、术后应激水平的差异,统计两组术后并发症情况。结果观察组的手术用时高于对照组（P<0.05）,其术中出血、术后引流量、切口长度以及住院时间均显著短于对照组（P<0.05）。两组术后6个月的功能恢复有效率分别为91.07%和71.92%,观察组显著高于对照组（P<0.05）。与术前相比,两组术后6个月跟骨宽度、高度、Bohle角均明显升高,Gissane角显著下降（P<0.05）。术后1 d,两组的疼痛应激指标P物质（SP）、神经肽Y（NPY）水平,炎症应激指标白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）水平均较术前提高明显（P<0.05）,且观察组上述指标均显著低于对照组（P<0.05）。两组的并发症发生率分别为7.15%和21.15%,观察组明显低于对照组（P<0.05）。结论与跟骨外侧L型入路相比,跗骨窦微创入路可明显减少跟骨骨折患者的手术创伤,促进其跟骨Bohle角、Gissane角的恢复,降低患者应激水平,并发症较少。

关键词: 跟骨骨折, 跗骨窦微创入路, 外侧扩大入路, 应激水平

Abstract: Objective To explore the effects of different approaches in the treatment of intra-articular calcaneal fractures and their effects on patients' stress levels. Methods A total of 108 patients with calcaneal intra-articular fractures admitted to our hospital from October 2016 to December 2019 were selected and divided into an observation group （56 cases） and a control group （52 cases） according to different approaches. The group was treated with a small incision in the sinus tarsi, and the control group was treated with an L-shaped incision in the lateral calcaneus. The perioperative situation of the two groups of patients was compared and analyzed. The American Foot and Ankle Association Foot Function Score System （AOFAS） was used to evaluate the functional recovery of the patients at 6 months after the operation. Imaging examination was performed at 6 months after the operation. The two groups were compared before the operation. Differences in postoperative stress levels, statistics of postoperative complications between the two groups. Results The operation time of the observation group was higher than that of the traditional group, and its intraoperative bleeding, postoperative drainage, incision length and hospital stay were significantly shorter than those of the control group （P<0.05）. The effective rates of functional recovery in the two groups at 6 months after operation were 91.07% and 71.92%, respectively. The observation group was significantly higher than the control group （P<0.05）. Compared with preoperatively, the width, height, and Bohle angle of the calcaneus in the two groups were significantly increased at 6 months after surgery, while the Gissane angle was significantly decreased （P<0.05）. 1 day after operation, the levels of pain stress index substance P （SP） and neuropeptide Y （NPY）, inflammation stress index interleukin-1β （IL-1β）, tumor necrosis factor-α （TNF-α） The level was significantly higher than that before operation （P<0.05）, and the above indicators in the observation group were significantly lower than those in the control group （P<0.05）. The incidence of complications in the two groups was 7.15% and 21.15%, respectively, and the observation group was significantly lower than the control group （P<0.05）. Conclusion Compared with traditional L-shape approach, minimally invasive sinus tarsi approach can significantly reduce surgical trauma of patients with calcaneal fractures, promote recovery of Bohle and Gissane angles of calcaneus, reduce the patient's stress level, with few complications and significant effects.

Key words: calcaneus fracture, minimally invasive sinus tarsi approach, lateral enlarged approach

中图分类号:

R683.42

翁科捷, 张育锋, 邱雪立, 陈树鑫, 沈晖扬, 刘成. 不同入路方式治疗跟骨关节内骨折的效果及对患者应激水平的影响[J]. 岭南现代临床外科, 2021, 21(06): 663-667.

WENG Ke-jie, ZHANG Yu-feng, QIU Xue-li, CHEN Shu-xin, SHEN Hui-yang, LIU Cheng. The effects of different approaches in the treatment of intra-articular calcaneal fractures and their effects on patients' stress levels[J]. Lingnan Modern Clinics In Surgery, 2021, 21(06): 663-667.

参考文献

[1] Gougoulias N, McBride D, Maffulli N. Outcomes of management of displaced intra-articular calcaneal fractures[J]. Surgeon, 2021, 19(5): e222-e229.
[2] Shi F, Wu S, Cai W, Zhao Y.Comparison of 5 Treatment Approaches for Displaced Intra-articular Calcaneal Fractures: A Systematic Review and Bayesian Network Meta-Analysis[J]. J Foot Ankle Surg, 2020, 59(6): 1254-1264.
[3] Lui TH, Pan XH, Pan Y.Arthroscopic and Endoscopic Management of Common Complications After Displaced Intra-Articular Calcaneal Fractures[J]. Clin Podiatr Med Surg, 2019, 36(2): 279-293.
[4] Mehta CR, An VVG, Phan K, et al.Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis[J]. J Orthop Surg Res, 2018, 13(1): 243.
[5] Kitaoka H B, Alexander I J, Adelaar R S, et al.Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes[J]. Foot Ankle Int, 1994, 15(7): 349-353.
[6] Al-Mudhaffar M, Prasad C, Mofidi A.Wound complications following operative fixation of calcaneal fractures[J]. Injury, 2000, 31(6): 461-464.
[7] Harvey EJ, Grujic L, Early JS, et al.Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach[J]. Foot Ankle Int, 2001, 22(11): 868-873.
[8] Shuler FD, Conti SF, Gruen GS, et al.Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures[J]. Orthop Clin N Am, 2001, 32(1): 187-192.
[9] Lin J, Xie C, Chen K, et al.Comparison of sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fractures Sanders type IV[J]. Int Orthop, 2019, 43(9): 2141-2149.
[10] Biggi F, Fabio SD, D′Antimo C, et al. Percutaneous calcaneoplasty in displaced intraarticular calcaneal fractures[J]. J Orthop Traumatol, 2013, 14(4): 307-310a.
[11] 段晓东, 王保云, 蔡长马. 跗骨窦切口空心钉与外侧L形切口钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的比较[J]. 中国骨与关节损伤杂志, 2021, 36(6): 639-641.
[12] 张大保, 毛波. 跗骨窦入路治疗跟骨Sanders Ⅱ、Ⅲ型骨折的体会[J]. 中国微创外科杂志, 2017, 17(3): 242-244, 248.
[13] Zhuang L, Wang L, Xu D, et al.Same wound complications between extensile lateral approach and sinus tarsi approach for displaced intra-articular calcaneal fractures with the same locking compression plates fixation: a 9-year follow-up of 384 patients[J]. Eur J Trauma Emerg Surg, 2021, 47(4): 1211-1219.
[14] Busel G, Mir HR, Merimee S, et al.Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach[J]. J Orthop Trauma, 2021, 35(6): 285-288.