刘征宇 崔军

[摘要]目的 探討跗骨窦入路空心钉内固定术对跟骨骨折踝-后足评分系统评分（AOFAS ）评分及并发症的影响。方法 选择我院2018年2月～2019年3月收治的80例跟骨骨折患者为研究对象，按随机数字表法分为两组，每组各40例。对照组实施外侧扩大型切口钢板内固定，观察组实施跗骨窦入路空心钉内固定。比较两组术后足部功能、术后3个月影像学指标、随访1年期间的AOFAS评分及并发症发生情况。结果 术后3个月，观察组跟骨结节高度及Bohler角大于对照组，跟骨宽度小于对照组，差异均有统计学意义（P<0.05）;术后3个月和术后1年，观察组AOFAS评分高于对照组，差异均有统计学意义（P<0.05）;术后1年，观察组发生切口感染、皮肤坏死、骨髓炎及腓肠神经损伤的总比例低于对照组，观察组足部功能评价优良率高于对照组，差异均有统计学意义（P<0.05）。结论 跗骨窦入路空心钉内固定术科有效促进跟骨骨折者跟骨解剖复位，促进术后足部功能恢复，并发症少，疗效高。

[关键词]跗骨窦入路;空心钉内固定;跟骨骨折;踝-后足评分系统评分;并发症

[中图分类号] R683.42          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0087-03

Effect of hollow nail internal fixation via tarsal sinus approach on AOFAS score and complications of calcaneal fracture

LIU Zheng-yu   CUI Jun▲

Department of Ankle Surgery， Affiliated Central Hospital of Shenyang Medical College， Liaoning Province， Shenyang   110000， China

[Abstract] Objective To investigate the effect of hollow nail internal fixation via tarsal sinus on AOFAS score and complications of calcaneal fracture. Methods A total of 80 patients with calcaneal fractures admitted in our hospital from February 2018 to March 2019 were selected as the research object， and were divided into two groups according to the random number table method， 40 cases in each group. The control group was internally fixed with lateral enlarged incision steel plate， and the observation group was internally fixed with hollow nails of tarsal sinus approach. The postoperative foot function， imaging indexes at 3 months after operation， AOFAS score and complications during the 1 year follow-up were compared between the two groups. Results Three months after operation， the height of calcaneal tubercle and Bohler angle of observation group were larger than that of control group， and the widths of calcaneus were smaller than control group， the differences were statistically significant （P<0.05）; 3 months after operation and 1 year after operation， the AOFAS scores of the observation group were higher than that of the control group， and the differences were statistically significant （P<0.05）; 1 year after surgery， the total proportion of incision infection， skin necrosis， osteomyelitis， and sural nerve injury in the observation group was lower than that in the control group， the good rate of foot function evaluation in the observation group was higher than that in the control group， and the differences were statistically significant （P<0.05）. Conclusion The tarsal sinus approach with hollow screw internal fixation can effectively promote the anatomical reduction of calcaneus in patients with calcaneal fractures， and promote the recovery of postoperative foot function with less complications and high efficacy.

[Key words] Tarsal sinus approach; Internal fixation with hollow nails; Calcaneal fracture; AOFAS score; Complication

跟骨为人体最大跗骨，为人体行走与負重功能最重要的支撑，研究提示其承担机体全身超过一半的重量，但跟骨解剖结构十分复杂，一旦发生骨折治疗难度较大，且效果不确定性高[1-2]。目前针对跟骨骨折的治疗目的在于恢复Bohler角、跟骨宽度、高度与长度、确保距下关节后关节面外形完整性[3]。一旦跟骨骨折处理不得当，可能影响足部功能进而导致行走与承重能力降低，甚至造成残疾而影响生活、生产能力[4]。临床治疗方法上最常用的为外侧扩大型切口钢板内固定及跗骨窦入路空心钉内固定[5]。其中外侧扩大型切口钢板内固定为以往常用方法，但手术创伤大，术后恢复慢，且并发症多，而跗骨窦入路空心钉内固定则有效的缩短了手术操作时间，达到促进术后早期愈合，缩短住院时间，提高术后足部功能的目的。……