关节镜下复位联合经皮螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析

doi:10.11958/20252115

天津医药 ›› 2025, Vol. 53 ›› Issue (11): 1191-1196.doi: 10.11958/20252115

关节镜下复位联合经皮螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析

宋康(), 董昱, 戴永文, 赵德源, 宋铁楠, 宋波, 徐刚^△()

徐州医科大学附属连云港医院（连云港市第一人民医院）足踝外科（邮编 222061）

收稿日期:2025-05-27 修回日期:2025-07-03 出版日期:2025-11-15 发布日期:2025-11-19
通讯作者: △E-mail：760020220019@xzhmu.edu.cn
作者简介:宋康（1997），男，医师，主要从事足踝外科方面研究。E-mail：1641782816@qq.com

The efficacy analysis of arthroscopic reduction combined with percutaneous screw technique in the treatment of Sanders type Ⅱ and type Ⅲ calcaneal fractures

SONG Kang(), DONG Yu, DAI Yongwen, ZHAO Deyuan, SONG Tienan, SONG Bo, XU Gang^△()

Department of Foot and Ankle Surgery, the First People's Hospital of Lianyungang, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, China

Received:2025-05-27 Revised:2025-07-03 Published:2025-11-15 Online:2025-11-19
Contact: △E-mail：760020220019@xzhmu.edu.cn

宋康, 董昱, 戴永文, 赵德源, 宋铁楠, 宋波, 徐刚. 关节镜下复位联合经皮螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析[J]. 天津医药, 2025, 53(11): 1191-1196.

SONG Kang, DONG Yu, DAI Yongwen, ZHAO Deyuan, SONG Tienan, SONG Bo, XU Gang. The efficacy analysis of arthroscopic reduction combined with percutaneous screw technique in the treatment of Sanders type Ⅱ and type Ⅲ calcaneal fractures[J]. Tianjin Medical Journal, 2025, 53(11): 1191-1196.

摘要/Abstract

摘要：

目的探讨关节镜下复位联合经皮螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法 48例SandersⅡ、Ⅲ型跟骨骨折患者根据手术方案的不同分为关节镜下复位联合经皮螺钉固定组（关节镜组）23例和跗骨窦入路切开复位联合螺钉内固定组（跗骨窦入路组）25例。比较2组患者手术时间、切口长度、术后并发症及内固定物二次取出情况；比较2组术后3个月、6个月及末次随访时跟骨结节关节（B?hler）角、跟骨交叉（Gissanes）角变化情况以及末次随访时美国足踝外科协会（AOFAS）评分、疼痛视觉模拟（VAS）评分。结果与跗骨窦入路组比较，关节镜组切口长度减小、手术时间延长，并发症发生率降低（P<0.05）。术后3个月、6个月及末次随访，关节镜组及跗骨窦入路组B?hler角、Gissanes角、AOFAS评分、VAS评分差异均无统计学意义（P>0.05）。结论 2组方案均能使患者获得良好的术后疗效，但在关节镜辅助下，手术切口天然具有微创优势，同时术后并发症发生率相较于跗骨窦入路低。

关键词: 骨折, 骨折固定术, 关节镜检查, 跟骨, 手术后并发症

Abstract:

Objective To explore the efficacy of arthroscopic reduction combined with percutaneous screw fixation in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures. Methods Forty-eight patients with Sanders types Ⅱ and Ⅲ calcaneal fractures were divided into the arthroscopic reduction combined with percutaneous screw fixation (arthroscopy) group (n=23) and the tarsal sinus approach open reduction combined with screw internal fixation (tarsal sinus approach) group (n=25) according to different surgical methods and plans. The operative time, incision length, postoperative complications and secondary removal of internal fixation were compared between the two groups. Changes in B?hler’s angle and Gissane’s angle were evaluated and compared between the two groups at 3 months, 6 months after operation and at the last follow-up. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and the visual analog scale (VAS) for pain were used to assess outcomes at the last follow-up. Results Compared with the tarsal sinus approach group, the incision length was reduced, the operation time was prolonged and the incidence of complications was decreased in the arthroscopic group (P<0.05). At 3 months, 6 months after the operation and the last follow-up, there were no significant differences in the B?hler Angle, Gissanes Angle, AOFAS and VAS scores between the arthroscopic group and the tarsal sinus approach group (P>0.05). Conclusion Both groups of regimens can enable patients to achieve good postoperative therapeutic efficacy. However, under arthroscopic assistance, surgical incisions inherently possess minimally invasive advantages, while the incidence of postoperative complications is lower compared to the sinus tarsi approach.

Key words: fracture, fracture fixation, arthroscopic examination, calcaneus, postoperative complications

中图分类号:

R687.3

图/表 7

表1 2组术前一般资料比较

Tab.1 Comparison of baseline characteristics before surgery between the two groups

组别	n	性别（男/女)	年龄/ 岁	BMI/ （kg/m²）	致伤原因（高处坠落/车祸）
跗骨窦入路组	25	17/8	41.7±11.4	21.9±2.13	14/11
关节镜组	23	16/7	41.5±11.7	22.1±2.62	13/10
t或χ²		0.014	0.059	0.825	0.001
组别	受伤腿侧（左/右）		Sanders分型（Ⅱ型/Ⅲ型）		伤后至手术时间/d
跗骨窦入路组	16/9		16/9		4.0（4.0，5.0）
关节镜组	15/8		16/7		4.0（3.5，5.0）
Z或χ²	0.016		0.193		0.940

表2 2组手术一般资料比较

Tab.2 Comparison of general surgical data between the two groups

组别	n	切口长度/cm	手术时间/min	内固定二次取出情况		并发症
组别	n	切口长度/cm	手术时间/min	因附骨窦疼痛取出	要求取出	伤口延迟愈合	跗骨窦区疼痛	足背外侧麻木
跗骨窦入路组	25	4.99±0.80	72.06±8.52	6	3	0	6	2
关节镜组	23	1.24±0.17	87.65±6.48	1	3	0	1	0
t、χ²或P		22.916^＊＊	7.094^＊＊	2.304	0.000	0.024^▲

图1 关节镜组SandersⅢ型跟骨骨折患者治疗过程及术后效果患者男，40岁，高处坠落致左侧SandersⅢ型跟骨骨折。A、B：术前冠状位CT及跟骨侧位；C：患者体位摆放；D：踝关节外侧入路关节镜检查；E：进入距下关节探查塌陷的骨折块；F：撬起塌陷的骨折块并临时克氏针固定；G、H：C臂机透视下跟骨骨折块克氏针临时固定及载距突螺钉置入；I：关节镜直视下观察复位情况及载距突螺钉位置；J：C臂机透视下拧入螺钉固定；K、L、M：术中、术后侧位及轴位透视影像；N、O：术后切口外观。

Fig.1 The treatment process and postoperative effect of patients with Sanders type III calcaneal fracture in the arthroscopic group

表3 2组患者术后3个月、6个月及末次随访时B?hler角、Gissanes角比较 ($\bar{x}\pm s$)

Tab.3 Comparison of B?hler’s angle and Gissane’s angle between patients of the two groups at 3 months, 6 months and the last follow-up

组别	n	B?hler角/°
组别	n	3个月	6个月	末次随访
跗骨窦入路组	25	28.2±3.5	26.9±4.1	25.9±5.8
关节镜组	23	27.4±3.1	26.3±4.5	24.4±5.7
t		0.840	0.481	0.904
组别	Gissanes角/°
组别	3个月		6个月	末次随访
跗骨窦入路组	122.5±3.1		119.6±3.8	116.5±3.7
关节镜组	121.2±2.9		118.2±3.0	115.2±3.6
t	1.501		1.423	1.233

表4 2组患者术后3个月、6个月及末次随访时AOFAS评分、VAS评分比较 ($\bar{x}\pm s$)

Tab.4 Comparison of AOFAS and VAS scores at 3 months, 6 months after surgery and the last follow-up between the two groups

组别	n	疼痛VAS/评分
组别	n	3个月	6个月	末次随访
跗骨窦入路组	25	2（2，3）	2（1，3）	1（1，1）
关节镜组	23	2（2，3）	2（1，3）	1（1，1）
Z		0.292	0.974	0.545
组别	AOFAS/分
组别	3个月		6个月	末次随访
跗骨窦入路组	85.4±1.1		87.2±1.7	90.8±2.7
关节镜组	85.7±1.4		87.8±1.9	91.3±2.9
t	0.821		1.149	0.617

图2 SandersⅡ型跟骨骨折患者术前及术后复位情况患者女，51岁，车祸致左侧SandersⅡ型跟骨骨折。A、B：术前跟骨侧位及冠状位CT提示关节面碎裂、塌陷，属于SandersⅡ型；C、D：术后3个月跟骨侧位及轴位X线片示跟骨骨折线模糊，复位未丢失；E、F：术后6个月跟骨侧位及轴位X线片示骨折线消失，复位未丢失；G、H：末次随访跟骨侧位及轴位X线片示骨折愈合，复位未丢失。

Fig.2 Preoperative and postoperative follow-up imaging findings in a patients with Sanders type Ⅱ calcaneal fracture

图3 SandersⅢ型跟骨骨折患者术前及术后复位情况患者男，42岁，高处坠落致左侧SandersⅢ型跟骨骨折。A、B：术前跟骨侧位及冠状位CT提示关节面碎裂、塌陷，属于SandersⅢ型；C、D：术后3个月跟骨侧位及轴位X线片示跟骨骨折线模糊，复位未丢失；E、F：术后6个月跟骨侧位及轴位X线片示骨折线消失，复位未丢失；G、H：末次随访跟骨侧位及轴位X线片示骨折愈合，复位未丢失。

Fig.3 Preoperative and postoperative follow-up imaging findings in the patient with Sanders type Ⅲ calcaneal fracture

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关节镜下复位联合经皮螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析

The efficacy analysis of arthroscopic reduction combined with percutaneous screw technique in the treatment of Sanders type Ⅱ and type Ⅲ calcaneal fractures

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