距下关节镜辅助对钉中钉治疗跟骨骨折临床效果的研究

A Study on the Clinical Effect of Subtalar Arthroscopic Assistance in the Treatment of Calcaneal Fractures with Nail-in-Nail Fixation

摘要: 目的：探究应用距下关节镜辅助复位钉中钉内固定治疗跟骨骨折的临床效果。方法：将2022年12月至2024年1月在莒县人民医院进行跟骨骨折手术治疗符合纳入标准的患者，按手术日期分别依次选取30例单纯钉中钉治疗患者(对照组)及30例距下关节镜辅助复位钉中钉治疗患者(治疗组)。记录两组患者的手术时间、术中出血量、围手术期切口情况、术后疼痛、住院时间及骨折愈合情况，术后影像学复查测量跟骨关节面平整度(关节面台阶CT ≥ 1 mm，X线 ≥ 2 mm)及关节腔整洁率(细小碎骨数 ≥ 1)；术后3个月及6个月时应用AOFAS标准评定足部功能。结果：经过6~15个月(平均9.25个月)的随访，两组患者在术中出血量、围手术期切口情况、术后疼痛(VAS评分)、住院时间及骨折愈合等方面无显著差异；在手术时间上治疗组稍长；在关节面平整度、关节腔整洁率及术后6个月时根据AOFAS标准评定患足功能恢复情况上，治疗组均优于对照组，差异有统计学意义(p < 0.05)。结论：在钉中钉内固定治疗跟骨骨折上，距下关节镜辅助复位改良了跟骨骨折跗骨窦撬拨复位钉中钉内固定的方法，便于术中观察关节面复位固定情况及距下关节内部整洁程度，进行关节腔清理，提升了钉中钉对跟骨骨折的治疗效果。

Abstract: Objective: To explore the clinical effect of subtalar arthroscopic-assisted reduction and intramedullary nail internal fixation in the treatment of calcaneal fractures. Methods: From December 2022 to January 2024, among the patients with calcaneal fractures admitted to Ju County People’s Hospital who met the inclusion criteria, 30 patients treated with simple intramedullary nail fixation (control group) and 30 patients treated with subtalar arthroscopic-assisted reduction and intramedullary nail fixation (treatment group) were successively selected according to the operation time. We record the operation time, intraoperative blood loss, perioperative incision conditions, postoperative pain, length of hospital stay, and fracture healing situation of the patients in both groups. After the operation, conduct imaging reexamination to measure the flatness of the calcaneal articular surface (the articular surface step is ≥1 mm on CT and ≥2 mm on X-ray) and the tidiness rate of the joint cavity (the number of fine broken bones is ≥1). We evaluate the foot function using the AOFAS standard at 3 months and 6 months after the operation. Results: After a follow-up period ranging from 6 to 15 months (with an average of 9.25 months), there were no significant differences between the two groups in terms of intraoperative blood loss, peri-operative incision conditions, postoperative pain (evaluated by Visual Analogue Scale, VAS score), length of hospital stay, and fracture healing. The operation time of the experimental group was slightly longer. There were statistical differences in the articular surface flatness and the cleanliness rate of the joint cavity (p < 0.05). Six months after the operation, the functional recovery of the affected foot was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) criteria. The treatment group showed better results than the control group, and the difference was statistically significant (p < 0.05). Conclusion: In the treatment of calcaneal fractures with intramedullary nail internal fixation, subtalar arthroscopic-assisted reduction improves the method of subtalar sinus pry reduction and intramedullary nail internal fixation for calcaneal fractures. It is convenient to observe the reduction and fixation condition of the articular surface and the tidiness degree of the inside of the subtalar joint during the operation, improves the treatment effect of the intramedullary nail, and has more advantages for the long-term functional recovery of the affected foot.