Open Reduction and Internal Fixation Via Sinus Tarsi Approach Combined with Small Lateral Incision for the Treatment of Sanders Type Ⅲ Calcaneal Fractures
Department of Orthopedics,Central Hospital of Liaocheng
Objective To investigate open reduction and internal fixation via sinus tarsi approach with anatomical locking plate in the treatment of sanders type Ⅲ calcaneal fractures.Methods Thirty-eight patients with unilateral Sanders type Ⅲ calcaneal fracture were recruited from February 2013 to February 2015.Patients were randomly divided into minimally invasive group and control group by random table method,with 19 cases in each group.The baseline information including age,sex,fracture cause,interval time from injury to operation,B-hler angle and Gissane angle before operation was analysed.All patients in the minimal invasive group underwent open reduction and internal fixation (ORIF) using sinus tarsi approach,and lateral L-type incision in the control group.B-hler angle and Gissane angle were measured before and after operation and the final follow-up inboth the two groups.American Orthopaedic Foot and Ankle Society(AOFAS) score were approved to evaluate the therapeutic effect after operation.Results There was no significant difference in age,sex,fracture cause,interval time from injury to operation,B-hler angle and Gissane angle before operation between the two groups.The average follow-up time was 14.1 months in minimal invasive group,and 14.8 months in control group.All patients in the two groups had bone union in final follow-up.B-hler angle was (12.9±5.4)° and (11.7±5.1)° in minimal invasive andcontrol group before operation.After operation,B-hler angle were (27.2±5.3)°in minimal invasive group and (28.1±6.3)° in the control group.Gissane angle was (108.5±8.6)° and (109.9±8.2)° beforeoperation in minimal invasive and control group.Gissane angle of observation group was (123.3±5.0)° and the control group was (124.7±5.4)° after operation.There was significant difference in B-hler angle and Gissane angle before andafteroperation in both minimal invasive group and control group (P<0.05).No significant difference was found in the median AOFAS score between the two groups (P>0.05).Three of skin necrosis and 1 of superficial infection were found in the control group,and no wound complications in the minimal invasive group.Three patients suffered from varying degrees of subtalar joint stiffness and 1 patients suffered from traumatic arthritis in the minimal invasive group,and there were9patients ofsubtalar joint stiffness and 3 patientsof traumatic arthritis in the control group.Conclusion ORIF via sinus tarsi approach and ORIF via a lateral L-type incisionhave similar therapeutic effect in the management of sanders type Ⅲ calcaneal fractures.And there are less incision complication and lower stiffness subtalar joint rate inORIF via sinus tarsi approach Patients.
侯正轩,李建波,刘宁波,袁文杰. 跗骨窦联合外侧小切口治疗Sanders Ⅲ型跟骨骨折[J]. 实用骨科杂志, 2018, 24(1): 25-30.
Hou Zhengxuan,Li Jianbo,Liu Ningbo,et al. Open Reduction and Internal Fixation Via Sinus Tarsi Approach Combined with Small Lateral Incision for the Treatment of Sanders Type Ⅲ Calcaneal Fractures. sygkzz, 2018, 24(1): 25-30.
[1]Hsu AR,Anderson RB,Cohen BE.Advances in surgical management of intra-articular calcaneus fractures[J].J Am Acad Orthop Surg,2015,23(7):399-407.
[2]Griffin D,Parsons N,Shaw E,et al.Operative versus non-operative treatment for closed,displaced,intra-articular fractures of the calcaneus:randomised controlled trial[J].BMJ,2014,349(1):g4483.
[3]Veltman ES,Doornberg JN,Stufkens SA,et al.Long-term outcomes of 1,730 calcaneal fractures:systematic review of the literature[J].J Foot Ankle Surg,2013,52(4):486-490.
[4]Yu X,Pang QJ,Chen L,et al.Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation:a review[J].J Int Med Res,2014,42(1):17-25.
[5]Wang YM,Wei WF.Sanders Ⅱ type calcaneal fractures:a retrospective trial of percutaneous versus operative treatment[J].Orthop Surg,2015,7(1):31-36.
[6]Kikuchi C,Charlton TP,Thordarson DB.Limited sinus tarsi approach for intra-articular calcaneus fractures[J].Foot Ankle Int,2013,34(12):1689-1694.
[7]Rammelt S,Winkler J,Zwipp H.Operative treatment of central talar fractures[J].Oper Orthop Traumatol,2013,25(6):525-541.
[8]Kline AJ,Anderson RB,Davis WH,et al.Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures[J].Foot Ankle Int,2013,34(6):773-780.
[9]王文强,白梅.跟骨外侧小切口联合跗骨窦间隙切口微创治疗跟骨骨折[J].实用骨科杂志,2016,22(5):454-456.
[10]伍凯,林健,黄建华,等.经跗骨窦切口与经外侧“L”型切口治疗SandersⅢ型骨折的疗效比较[J].中华骨科杂志,2015,35(8):825-832.
[11]Molloy AP,Lipscombe SJ.Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions[J].Foot Ankle Clin,2011,16(1):165-179.
[12]Hollawell S.Wound closure technique for lateral extensile approach to intra-articular calcaneal fractures[J].J Am Podiatr Med Assoc,2008,98(5):422-425.
[13]Wu K,Wang C,Wang Q,et al.Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures[J].J Res Med Sci,2014,19(6):495-501.
[14]施忠民,邹剑,顾文奇,等.经跗骨窦间隙与外侧“L”形切口治疗SandersⅡ型跟骨骨折的疗效比较[J].中华骨科杂志,2013,33(4):298-303.
[15]辛宗山,郑军,操儒道,等.闭合复位与切开复位内固定治疗 Sander Ⅱ型跟骨骨折的比较[J].实用骨科杂志,2015,21(12):1134-1137.
[16]Bibbo C,Ehrlich DA,Nguyen HM,et al.Low Wound complication rates for the lateral extensile approach for calcaneal ORIF when the lateral calcaneal artery is patent[J].Foot Ankle Int,2014,35(7):650-656.
[17]Zhang T,Su Y,Chen W,et al.Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion:longitudinal approach versus sinus tarsi approach[J].J Bone Joint Surg (Am),2014,96(4):302-309.
[18]Zwipp H,Rammelt S,Amlang M,et al.Operative treatment of displaced intra-articular calcaneal fractures[J].Oper Orthop Traumatol,2013,25(6):554-568.