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Title: [Minimally invasive tarsal sinus incision combined with manipulative reduction and internal fixation for calcaneal fractures of Sanders typeⅡ and Ⅲ].
Author: Chen M, Deng K, Zeng WH, Zeng JJ, Zhong QS, Han ZM.
Journal: Zhonghua Wai Ke Za Zhi; 2017 Mar 01; 55(3):220-223. PubMed ID: 28241725.
Abstract:
Objective: To evaluate the method and curative effect of plate fixation or percutaneous screws for the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ via a minimally invasive sinus tarsi incision combined with a variety of manipulative reduction methods. Methods: Twenty-one patients with closed calcaneal fractures treated in the Department of Orthopedics, the First Affiliated Hospital of Nanchang University from January 2014 to January 2016 were collected. There were 15 men and 6 women, with an average age of 39.3 years(from 25 to 63 years). According to the Sanders classification, 16 cases were type Ⅱ and 5 were type Ⅲ.All cases were treated with internal fixation with plate and percutaneous screws via the mini-open sinus tarsi approach following reduction of the posterior articular surface of the subtalar joint and calcaneal length, width and height.Statistical analysis was performed on calcaneal width and Böhler angle, Gissane angle preoperatively and postoperatively (3 days and 3 months). All data were analyzed by ANOVA, functional recovery was evaluated according to the Ankle and Hind-foot Score of American Orthopedic Foot and Ankle Society (AOFAS). Results: Twenty one patients were followed up for a mean duration of 13.4 months(6 to 24 months). All cases gained primary incision healing, without complications such as skin necrosis, wound infection, tenosynovitis of peroneus longus and brevis muscles, or fracture displacement and hardware failure.Bone union was achieved at an average of 10.5 weeks(9 to 11 weeks). No obvious malunion occurred by the last follow-up. Compared to preoperative, calcaneal width(F=25.62, 38.90) were significantly improved 3 days and 3 months after surgery, Böhler angle(F=440.24, 272.42) and Gissane angle(F=91.86, 43.74) were normal, the differences were statistically significant (all P<0.05). Compared to 3 days after surgery, calcaneal width, Böhler angle and Gissane angle kept normal 3 months after surgery, there were no statistically differences (F=0.26, 1.35, 2.60, all P>0.05). By the AOFAS scoring, 10 cases were rated as excellent, 7 were good and 4 were fair. Conclusions: Fixation with plate and percutaneous screws via the mini-open sinus tarsi approach is an effective treatment for Sanders types Ⅱ and Ⅲ calcaneal fractures, which with the advantages of small wound, simple operation, reliable fixation, no incision complication, especially suitable for elderly patients and the patients with severe injury of local soft tissue. 目的：探讨微创跗骨窦小切口结合多种复位手法联合接骨板及经皮螺钉内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效。 方法：收集2014年1月至2016年1月南昌大学第一附属医院骨科收治的21例闭合性跟骨骨折患者的临床资料，男性15例，女性6例；年龄25～63岁，平均39.3岁。Sanders分型：Ⅱ型16例，Ⅲ型5例。采用微创跗骨窦小切口结合多种复位手法复位关节面，以接骨板及经皮螺钉内固定进行治疗。采用方差分析对术前、术后3 d、术后3个月的跟骨宽度、Böhler角、Gissane角进行统计学分析，应用美国足踝外科协会的踝-后足评分标准评定疗效。 结果： 21例患者术后获6～24个月随访，平均13.4个月。切口均一期愈合，无切口皮缘坏死和感染、腓骨长短肌腱鞘炎，未出现骨折移位或内固定失败等情况。骨折愈合时间9～11周，平均10.5周，未发生畸形愈合。与术前相比，术后3 d和末次随访时跟骨宽度(F＝25.62、38.90)明显降低，Böhler角(F＝440.24、272.42)和Gissane角(F＝91.86、43.74)明显增大，差异均有统计学意义(P值均<0.05)；与术后3 d相比，末次随访时跟骨宽度、Böhler角和Gissane角的变化结果差异无统计学意义(F＝0.26、1.35、2.60；P值均>0.05)。美国骨科足踝外科学会踝-后足评分：优10例，良7例，可4例。 结论：微创跗骨窦小切口手法复位内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折具有创伤小、操作简单、复位固定可靠、无切口并发症等优点，尤其适宜老年患者及局部软组织损伤严重者。.

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