[Effectiveness analysis of modified tarsal sinus approach for Sanders II- IIItype calcaneal fractures].

目的: 探讨改良跗骨窦入路与传统跗骨窦入路治疗 SandersⅡ～Ⅲ 型跟骨骨折的近期临床疗效。. Methods: Between January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative Bohler angle, Gissane angle, visual analogue scale (VAS) core ( P>0.05), which were comparable. The operation time, postoperative drainage volume, postoperative Bohler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness. 结果: 53 例患者均顺利完成手术，无血管神经损伤、围手术期死亡等严重并发症。两组患者手术时间及术后引流量比较差异无统计学意义（ P>0.05）。两组患者均获随访，随访时间 12～36 个月，平均 17 个月。术后未发生骨折移位、内固定失败、骨折畸形愈合等；所有患者均未行二期关节融合手术。两组骨折愈合时间比较差异无统计学意义（ t=0.30， P=0.77）。两组术后 2 d Bohler 角、Gissane 角均较术前显著改善（ P 0.05）。两组术后 24 h 及 1 年 VAS 评分均较术前显著改善（ P 0.05）。两组术后 1 年 AOFAS 评分比较差异无统计学意义（ t=1.46， P=0.15）；但观察组术后 1 年 SF-36 量表评分显著高于对照组（ t=2.08， P=0.04）。末次随访时，观察组 2 例、对照组 8 例患者出现距下关节僵硬或疼痛，两组发生率比较差异无统计学意义（ χ2=1.98， P=0.16）。. 结论: 采用改良跗骨窦入路治疗 SandersⅡ～Ⅲ 型跟骨骨折，具有创伤小、直视下复位清晰、复位固定可靠、切口并发症少等优点。.