关节镜技术联合钉中钉系统全内修复跟骨关节内骨折的临床疗效观察

Observation of the clinical efficacy of arthroscopic technique combined with nail-in-nail system for total internal repair of intra-articular fracture of calcaneus

摘要:

目的 探讨关节镜技术联合钉中钉系统全内修复跟骨关节内骨折的临床疗效。方法 回顾性分析2021年5月－2024年4月该院骨与关节康复科收治，并获得随访的31例闭合性跟骨关节内骨折患者的临床资料。均采取关节镜技术联合钉中钉系统全内修复手术治疗方案。术前及术后均行跟骨侧轴位X线片及足部CT检查，根据影像学结果对骨折类型进行分型，并评价术后骨折复位情况。比较手术前后跟骨高度、宽度、Bohler角和Gissane角。记录术前等待时间、手术时间、术中出血量、住院时间、术后疼痛视觉模拟评分法（VAS）评分等围手术期相关指标及术后并发症发生情况。采用美国足踝外科协会（AOFAS）评分和Maryland足部评分评估临床疗效。结果 术后影像学检查，可见跟骨术后关节面塌陷骨块复位；跟骨高度明显高于术前，跟骨宽度明显窄于术前，Bohler角较术前明显增大，Gissane角较术前明显缩小，差异均有统计学意义（P < 0.05）。术前等待时间为6（4，7）d，手术时间为（188.77±39.53）min，术中出血量为（59.03±23.00）mL，住院时间为（16.49±4.04）d，术后疼痛VAS评分为2（1，2）分，AOFAS评分为92（90，95）分，Maryland评分为92（90，95）分。结论 采用关节镜技术联合钉中钉系统全内修复跟骨骨折，具有可早期开展手术、创伤小、直视下复位、固定可靠和无切口相关并发症等优点，适用于Sanders Ⅱ型和Ⅲ型跟骨骨折。值得应用于临床。

Abstract:

Objective To explore the clinical efficacy of arthroscopic technique combined with nail-in-nail system for total internal repair of intra-articular fracture of calcaneus.Method A retrospective analysis was conducted on the clinical data of 31 patients with closed intra-articular fracture of calcaneus from May 2021 to April 2024 and were followed up. All adopted the treatment plan of arthroscopic technique combined with the nail-in-nail system for total internal repair surgery. Axial X-ray films of the calcaneus side and CT examinations of the foot were performed both before and after the operation. The fracture types were classified based on the imaging results, and the fracture reduction after the operation was evaluated. Compare calcaneal height, width, Bohler angle, and Gissane angle before and after surgery. Perioperative related indicators such as preoperative waiting time, operation duration, intraoperative blood loss, total hospital stay, postoperative pain visual analogue score (VAS) score and postoperative complications were recorded. The clinical efficacy was evaluated by using the American Orthopaedic Foot and Ankle Society (AOFAS) score and Maryland foot score.Results Postoperative imaging examination showed that the articular surface collapsed bone was reduced after calcaneus surgery. The calcaneus height was significantly higher than that before surgery, the calcaneus width was significantly narrower than that before surgery, the Bohler angle was significantly larger than that before surgery, and the Gissane angle was significantly smaller than that before surgery, and the differences were statistically significant, P < 0.05. The preoperative waiting time was 6 (4,7) d, the operation time was (188.77 ± 39.53) min, the intraoperative blood loss was (59.03 ± 23.00) mL, the hospital stay was (16.49 ± 4.04) d, the postoperative pain VAS score was 2 (1, 2) points, the AOFAS score was 92 (90, 95) points, and the Maryland score was 92 (90, 95) points.Conclusion The total internal repair of fracture of calcaneus using arthroscopic technology combined with the nail-in-nail system has the advantages of early surgical intervention, minimal trauma, direct visual reduction, reliable fixation, and no incision-related complications. It is suitable for Sanders type II and III fracture of calcaneus. It is worth applying in clinical practice.