牟遐平　　戢勇　　罗德军　　张兆尧　　朱庆茂

[摘要] 目的 探討经跗骨窦入路微创治疗跟骨骨折畸形愈合的临床效果。 方法 选取2017年1月至2018年12月本院收治的跟骨骨折畸形愈合患者96例（96足），按随机数字表法分为对照组和研究组，每组各48例（48足）。对照组予传统外侧“L”形切口手术治疗，研究组予经跗骨窦入路微创手术治疗。观察比较两组一般手术指标、术后并发症情况及手术前后影像学参数和疗效的差异。 结果 研究组切口长度、手术时间均明显短于对照组，差异有统计学意义（P<0.05）;研究组术中出血量、术后出血量均明显少于对照组，差异有统计学意义（P<0.05）;研究组术后并发症总发生率明显低于对照组，差异有统计学意义（P<0.05）;术后两组Gissane角、跟骨Bohler角、跟骨宽度、跟距骨高度及距骨倾斜角较术前均明显改善，差异有统计学意义（P<0.05），但两组间比较，差异均无统计学意义（P>0.05）;两组疗效优良率比较，差异无统计学意义（P>0.05）。 结论 经跗骨窦入路微创治疗跟骨骨折畸形愈合具有理想的临床效果，与传统外侧“L”形切口术式疗效相近，同时还具有切口长度短、出血量少、手术时间短及术后并发症总发生率低的优点，值得临床推荐。

[关键词] 跗骨窦入路;微创;跟骨骨折;畸形愈合

[中图分类号] R683.42          [文献标识码] B          [文章编号] 1673-9701（2021）09-0106-04

Minimally invasive treatment of malunion of calcaneus fracture via tarsal sinus approach

MU Xiaping   JI Yong   LUO Dejun   ZHANG Zhaoyao   ZHU Qingmao

Department of Orthopedics， the People′s Hospital of Jianyang City in Sichuan Province， Jianyang   641400， China

[Abstract] Objective To investigate the clinical efficacy of minimally invasive treatment of malunion of calcaneus fracture via tarsal sinus approach. Methods A total of 96 patients（96 feet） of calcaneal fracture malunion admitted to our hospital from January 2017 to December 2018 were selected， and they were divided into the control group and the study group according to the random number table method， with 48 cases（48 feet ） in each group. The control group was treated with conventional lateral L-shaped incision， while the study group was treated with minimally invasive surgery via tarsal sinus approach. The differences of general operation indexes， incidence of postoperative complications， imaging parameters before and after operation and therapeutic efficacies were observed and compared between the two groups. Results The length of incision， operation duration of the study group were obviously shorter than those of the control group， the differences were statistically significant（P<0.05）. The hemorrhage volume during and after operation of the study group were obviously less than those of the control group， the differences were statistically significant（P<0.05）. The total incidence of postoperative complications of the study group was obviously lower than that of the control group， the difference was statistically significant（P<0.05）. The Gissane angle， calcaneus Bohler angle， calcaneus width， calcaneus talus height and talus inclination angle of the two groups were all statistically significantly improved after operation than before operation（P<0.05）. Meanwhile， there were no significant differences between the two groups in the above imaging parameters（P>0.05）. There were no significant differences between the two groups in the excellent or good rates of therapeutic efficacy（P>0.05）. Conclusion Minimally invasive treatment of malunion of calcaneus fracture via tarsal sinus approach has ideal clinical efficacy， which is similar to the conventional lateral L-shaped incision， and has the advantages of short incision length， less hemorrhage volume， short operation duration and lower total incidence of postoperative complications， which is worthy of clinical recommendation.

[Key words] The tarsal sinus approach; Minimally invasive; Calcaneal fracture; Malunion

跟骨为足弓的重要组成部分，跟骨骨折愈合畸形通常指根骨骨折后由于手术解剖复位较为困难、初次手术治疗复位不理想、治疗方法不正确或延误治疗等原因，导致的后期足弓扁平或足外翻等畸形表现[1-2]，对患者行走、活动功能有很大的影响。传统外侧“L”形切口术式治疗跟骨骨折畸形愈合疗效肯定，但该术式具有较大的创伤性，术后并发症也较多，不利于患者的预后[3-4]。近年来，微创手术因其创伤小、疗效好等特点获得了广大患者及医生的认可。本研究旨在探讨经跗骨窦入路微创治疗跟骨骨折畸形愈合的临床效果，以2017年1月至2018年12月本院收治的跟骨骨折畸形愈合患者96例为研究对象，比较两种不同治疗方法，为临床治疗提供一定的参考，现报道如下。