摘要
目的观察比较跗骨窦“八”字切口入路与传统“L”形切口入路下钢板内固定治疗SandersⅢ型跟骨骨折的疗效及对患者骨折复位、疼痛介质的影响。方法回顾性选取我院收治的SandersⅢ型跟骨骨折患者97例,依据治疗方案不同分为“八”字入路组(n=54)和“L”形入路组(n=53),“L”形入路组行传统“L”形切口入路下钢板内固定治疗,“八”字入路组行跗骨窦“八”字切口入路下钢板内固定治疗。比较2组患者围术期手术指标,术前及术后1 d、3 d疼痛介质[5羟色胺(5-HT)、前列腺素E_(2)(PGE_(2))、P物质(SP)]水平,术后并发症,术前及术后3个月、12个月影像学指标(Gissane角、Bohler角、跟骨高度),术后12个月手术优良率。结果2组患者手术时间、骨折愈合时间比较差异无统计学意义(P>0.05);“八”字入路组患者住院时间短于“L”形入路组,术中出血量少于“L”形入路组,差异均有统计学意义(P<0.05)。2组患者血清5-HT、PGE_(2)、SP水平组间、不同时间点及交互作用比较,差异有统计学意义(P<0.05);“八”字入路组术后1 d、3 d血清5-HT、PGE_(2)、SP水平较“L”形入路组低(P<0.05)。“八”字入路组术后并发症发生率(3.70%)低于“L”形入路组(16.98%),差异有统计学意义(P<0.05)。2组患者术前及术后3个月、12个月Gissane角、Bohler角、跟骨高度比较,差异无统计学意义(P>0.05);2组患者术后3个月、12个月Gissane角、Bohler角、跟骨高度均较术前增加(P<0.05)。2组患者术后12个月手术优良率比较差异无统计学意义(P>0.05)。结论在SandersⅢ型跟骨骨折的治疗中,传统“L”形切口入路和跗骨窦“八”字切口入路下钢板内固定疗效均确切,可恢复跟骨结构和形态,但后者可减少术中出血量,提高手术效果,降低并发症风险,减少疼痛介质释放,对患者术后早期恢复、预后改善更有优势。
Objective To observe and compare the efficacies of steel plate internal fixation via the“八”-shaped incision approach of tarsal sinus and the traditional“L”-shaped incision approach in the treatment of Sanders typeⅢcalcaneal fracture and their effects on fracture reduction and pain mediators of the patients.Methods A total of 97 patients with Sanders typeⅢcalcaneal fracture treated in our hospital were retrospectively selected and divided into the“八”-shaped approach group(n=54)and the“L”-shaped approach group(n=53)according to different treatment plans.Patients in the“L”-shaped approach group were treated with steel plate internal fixation via the traditional“L”-shaped incision approach,and patients in the“八”-shaped approach group were treated with steel plate internal fixation via the“八”-shaped incision approach of tarsal sinus.The perioperative operative indicators,the levels of pain mediators[5-hydroxytryptamine(5-HT),prostaglandin E 2(PGE 2),and substance P(SP)]before operation,1 day and 3 days after operation,postoperative complications,imaging indexes(Gissane angle,Bohler angle,calcaneus height)before operation,3 months and 12 months after operation,and the excellent and good rate of operation 12 months after operation of the two groups were compared.Results There was no statistically significant difference in the operation time or fracture healing time between the two groups(P>0.05);the hospital stay in the“八”-shaped approach group was shorter than that in the“L”-shaped approach group,and the intraoperative bleeding volume was less than that in the“L”-shaped approach group,and the differences were statistically significant(P<0.05).There were statistically significant differences in serum levels of 5-HT,PGE 2 and SP between the two groups,at different time points and interaction(P<0.05);the serum levels of 5-HT,PGE 2 and SP 1 day and 3 days after operation in the“八”-shaped approach group were lower than those in the“L”-shaped approach group(P<0.05).The incidence of postoperative complications in the“八”-shaped approach group(3.70%)was lower than that in the“L”-shaped approach group(16.98%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in the Gissane angle,Bohler angle or calcaneal height before operation,3 months and 12 months after operation between the two groups(P>0.05);the Gissane angle,Bohler angle,and calcaneal height 3 months and 12 months after operation of the two groups increased compared with those before operation(P<0.05).There was no statistically significant difference in the excellent and good rate of operation 12 months after operation between the two groups(P>0.05).Conclusion Steel plate internal fixation via the traditional“L”-shaped incision approach and the“八”-shaped incision approach of tarsal sinus are effective in the treatment of Sanders typeⅢcalcaneal fracture,and can restore the calcaneal structure and morphology,but the latter can reduce the intraoperative bleeding volume,improve the effect of operation,reduce the risk of complications and the release of pain mediators,which is more advantageous for early postoperative recovery and improvement of prognosis of patients.
作者
赵雁波
张晨阳
陈兴康
王国平
ZHAO Yan-bo;ZHANG Chen-yang;CHEN Xing-kang;WANG Guo-ping(Department of Orthopedics,Air Force Hospital of the Central Theater of the Chinese People’s Liberation Army,Datong Shanxi 037004,China)
出处
《局解手术学杂志》
2022年第8期721-725,共5页
Journal of Regional Anatomy and Operative Surgery
基金
山西省科研立项课题[(2019)569号]。
关键词
跗骨窦“八”字切口入路
传统“L”形切口入路
内固定
跟骨骨折
骨折复位
疼痛介质
手术优良率
“八”-shaped incision approach of tarsal sinus
traditional“L”-shaped incision approach
internal fixation
calcaneal fracture
fracture reduction
pain mediator
excellent and good rate of operation
