跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折的并发症及影响因素分析

周明平; 郑强; 邹光翼

doi:10.16766/j.cnki.issn.1674-4152.002538

跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折的并发症及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002538

周明平^{1, 2},
郑强^1, ,,
邹光翼²

1.
浙江大学医学院附属第二医院创伤骨科，浙江杭州 310000
2.
丽水市人民医院创伤骨科，浙江丽水 323000

基金项目:

浙江省医药卫生科技计划项目 2021PY032

详细信息

通讯作者:
郑强, E-mail: 2100057@zju.edu.cn

中图分类号: R683.42 R687.3
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-26
- 网络出版日期: 2022-09-23

Analysis of complications and influencing factors of sinus tarsal incision mini-plate combined with hollow nail internal fixation for treatment of calcaneal fractures

1.
Department of Orthopedics, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的研究跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折的并发症及影响因素。方法选取2018年7月—2020年6月浙江大学医学院附属第二医院创伤骨科收治的84例跟骨骨折患者，并对其临床资料进行回顾性研究，根据不同术式将其分为对照组和跗骨窦组，每组各42例。对照组行外侧“L”形切口内固定手术，跗骨窦组行跗骨窦切口微创钢板及空心钉轴向内固定手术，比较切口长度、出血量、消肿时间、愈合拆线时间、Bohler角、Gissane角、后踝后足功能改善率、并发症发生率。采用logistic回归分析研究术后并发症的影响因素。结果跗骨窦组切口长度、出血量、消肿时间、愈合拆线时间短于对照组，差异有统计学意义(均P＜0.05)。Bohler角跗骨窦组高于对照组，差异有统计学意义(P＜0.05), 而2组Gissane角差异无统计学意义(P＞0.05)。跗骨窦组总改善率为90.5%(38/42)，高于对照组61.9%的改善率(26/42, P＜0.05)。跗骨窦组并发症发生率为28.6%(12/42)，低于对照组50.0%(21/42)的发生率，差异有统计学意义(P＜0.05)。回归分析显示手术方式、消肿时间、愈合拆线时间、Bohler角、年龄、功能改善是影响术后并发症发生的因素。结论跗骨窦切口微型钢板联合空心钉内固定治疗跟骨骨折优于L形切口，而手术方式、消肿时间、愈合拆线时间、Bohler角、年龄、功能改善等因素影响手术预后效果。
- 跗骨窦切口 /
- 空心钉内固定 /
- 跟骨骨折 /
- 并发症 /
- 影响因素
Abstract: Objective To explore the complications and influencing factors of calcaneal fractures treated with tarsal sinus incision microplate combined with cannulated screw internal fixation. Methods From July 2018 to June 2020, 84 patients with calcaneal fractures admitted to the Department of Traumatology and Orthopaedics of the Second Affiliated Hospital of Zhejiang University School of Medicine were selected, and their clinical data were retrospectively studied. They were divided into control group and tarsal sinus group in accordance with different surgical procedure, with 42 cases in each group. The control group underwent lateral "L"-shaped incision internal fixation and the tarsal sinus group underwent minimally invasive tarsal sinus incision plate and cannulated screw axial internal fixation. The Bohler angle, Gissane angle, improvement rate of hind ankle and hindfoot function and complication rate were determined. Logistic regression was used to analyse the influencing factors of postoperative complications. Results The length of incision, the amount of blood loss, the time for detumescence and the time for healing and removing sutures in the sinus tarsi group were shorter than those in the control group, the differences were statistically significant (all P < 0.05). The Bohler angle was higher in the sinus tarsi group than in the control group and the difference was statistically significant (P < 0.05). On the contrary, no significant difference was found in the Gissane angle between the two groups (P>0.05). The total improvement rate of the sinus tarsi group was 90.5% (38/42), which was higher than that of the control group at 61.9% (26/42), and the difference was statistically significant (P < 0.05). The incidence of complications in the sinus tarsi group (28.6%, 12/42) was lower than that in the control group (50.0%, 21/42) and the difference was statistically significant (P < 0.05). Regression analysis showed that operation method, swelling time, suture removal time, Bohler angle, age, and functional improvement were independent risk factors for postoperative complications. Conclusion Tarsal sinus incision microplate combined with cannulated screw internal fixation is better than L-shaped incision in the treatment of calcaneal fractures. Factors such as surgical method, detumescence time, healing and suture removal time, Bohler angle, age and functional improvement affect the prognosis of surgery.
- Sinus tarsal incision /
- Cannulated nail internal fixation /
- Calcaneal fracture /
- Complications /
- Influencing factors

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图 1 跗骨窦切口微创钢板及空心钉轴向内固定手术2例情况

注：A、B、C为45岁跟骨粉碎性骨折患者，术前CT提示关节面塌陷。A为手术切口；B为术后侧位片，提示骨折端位置良好，固定牢靠；C为术后跟骨轴位片，无明显内翻，螺钉长度合适。D、E、F为52岁跟骨粉碎性骨折患者。D为术前侧位片，见跟骨粉碎性骨折；E为手术切口；F示内固定良好，骨折端已愈合。

Figure 1. Two cases of minimally invasive tarsal incision and hollow nail axial fixation

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表 1 2组跟骨骨折患者基线资料情况

Table 1. Baseline data of patients with calcaneal fractures in the two groups

组别	例数	性别[例(%)]		骨折部位[例(%)]		分型[例(%)]		年龄(x±s，岁)
组别	例数	男性	女性	右侧	左侧	Ⅱ型	Ⅲ型	年龄(x±s，岁)
对照组	42	23(54.8)	19(45.2)	21(50.0)	21(50.0)	22(52.4)	20(47.6)	55.45±10.42
跗骨窦组	42	25(59.5)	17(40.5)	24(57.1)	18(42.9)	26(61.9)	16(38.1)	57.23±8.45
统计量		0.194^a		0.431^a		0.378^a		0.860^b
P值		0.659		0.512		0.508		0.392
注：^a为χ²值，^b为t值。

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表 2 2组跟骨骨折患者围手术期指标比较(x±s)

Table 2. Comparison of perioperative indexes between two groups of patients with calcaneal fracture

组别	例数	切口长度(cm)	出血量(mL)	消肿时间(d)	愈合时间(d)	愈合拆线时间(d)	Bohler角(°)	Gissane角(°)
跗骨窦组	42	5.14±1.25	27.89±14.68	2.08±0.47	46.68±8.49	13.58±0.68	30.69±5.68	128.36±14.68
对照组	42	11.36±1.31	86.69±13.78	3.38±1.24	53.49±10.47	19.68±0.53	28.24±5.37	123.67±14.38
t值		22.252	18.927	6.348	3.274	45.876	2.031	1.479
P值		＜0.001	＜0.001	＜0.001	0.002	＜0.001	0.045	0.143

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表 3 2组跟骨骨折患者后踝后足功能改善率比较[例(%)]

Table 3. Comparison of function improvement rate of posterior ankle and hind foot in patients with calcaneal fracture between two groups[cases(%)]

组别	例数	优	良	可	差	总改善
跗骨窦组	42	13(31.0)	16(38.1)	9(21.4)	4(9.5)	38(90.5)
对照组	42	3(7.1)	10(23.8)	13(31.0)	16(38.1)	26(61.9)
注：2组总改善率比较，χ²=9.450, P=0.002。

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表 4 2组跟骨骨折患者并发症总发生率比较[例(%)]

Table 4. Comparison of the total incidence of complications in patients with calcaneal fracture between two groups[cases(%)]

组别	例数	关节疼痛	距下关节炎	软组织损伤	切口红肿	皮缘坏死	总发生
跗骨窦组	42	1(2.4)	1(2.4)	1(2.4)	5(11.9)	4(9.5)	12(28.6)
对照组	42	4(9.5)	6(14.3)	4(9.5)	4(9.5)	3(7.1)	21(50.0)
注：2组总发生率比较，χ²=4.043，P=0.044。

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表 5 有无并发症跟骨骨折患者基础情况比较

Table 5. Comparison of basic condition of patients with and without complication calcaneal fracture

项目	并发症		统计量	P值
项目	无(n=51)	有(n=33)	统计量	P值
手术方式[例(%)]			4.043^a	0.044
联合术式(n=42)	21(41.2)	21(63.6)
外侧术式(n=42)	30(58.8)	12(36.4)
性别[例(%)]			0.004^a	0.949
男性(n=48)	29(56.9)	19(57.6)
女性(n=36)	22(43.1)	14(42.4)
骨折部位[例(%)]			0.350^a	0.554
右侧(n=45)	26(51.0)	19(57.6)
左侧(n=39)	25(49.0)	14(42.4)
分型[例(%)]			0.266^a	0.606
Ⅱ型(n=48)	28(54.9)	20(60.6)
Ⅲ型(n=36)	23(45.1)	13(39.4)
功能改善[例(%)]			18.243^a	＜0.001
无改善(n=20)	4(7.8)	16(48.5)
有改善(n=64)	47(92.2)	17(51.5)
消肿时间(x±s，d)	2.49±0.97	3.10±1.29	2.460^b	0.016
愈合拆线时间(x±s，d)	16.15±3.03	17.37±3.18	1.756^b	0.083
Bohler角(x±s，°)	29.24±6.13	29.81±4.83	0.452^b	0.652
Gissane角(x±s，°)	126.55±16.11	125.19±12.19	0.415^b	0.679
切口长度(x±s，cm)	7.75±3.18	9.02±3.57	1.701^b	0.093
出血量(x±s，mL)	62.08±34.08	49.88±29.66	1.685^b	0.096
年龄(x±s，岁)	59.02±15.66	64.06±15.17	1.467^b	0.146
愈合时间(x±s，d)	49.38±11.68	51.47±11.38	1.970	0.052
注：^a为χ²值, ^b为t值。

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表 6 跟骨骨折患者并发症影响因素的多因素logistic回归分析

Table 6. Multivariate logistic regression analysis of influencing factors of complications in patients with calcaneal fracture

变量	B	SE	Wald χ²	P值	OR值	95% CI
手术方式	-11.641	4.726	6.067	0.014	0.000	0.000~0.093
消肿时间	1.026	0.437	5.526	0.019	2.791	1.186~6.568
愈合拆线时间	-1.991	0.781	6.494	0.011	0.137	0.030~0.631
Bohler角	0.155	0.077	4.050	0.044	1.167	1.004~1.357
年龄	-0.052	0.022	5.896	0.015	0.949	0.910~0.990
功能改善	-2.546	0.754	11.386	0.001	0.078	0.018~0.344

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