MEDLINE/PubMed Journal Browser Search

Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

Title: [Effectiveness of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach for Sanders type Ⅱ and Ⅲ calcaneal fractures].
Author: Wang Y, Ye G, Zhang Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Dec 15; 36(12):1471-1478. PubMed ID: 36545854.
Abstract:
OBJECTIVE: To investigate the effectiveness of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. METHODS: A clinical data of 46 patients with Sanders type Ⅱand Ⅲ calcaneal fractures met the selective criteria between March 2016 and March 2021 was retrospectively analyzed. The factures were fixed with minimally invasive plate and medial supporting cannulated screws via tarsal sinus approach in 20 cases (group A) and with minimally invasive plate in 26 cases (group B). There was no significant difference between groups in term of the gender, age, injury causes, fracture type and side, the time from injury to operation, and preoperative calcaneal length and width, Böhler angle, Gissane angle, and visual analogue scale (VAS) score ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing were recorded. The pain improvement of patients was evaluated by VAS scores before operation and at 48 hours after operation. The ankle joint function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 12 months after operation. Besides, the calcaneal length and width, Böhler angle, and Gissane angle were measured by X-ray films before and after operation. Furthermore, the difference (loss value) between 3, 12 months and 1 day after operation was calculated. Moreover, the fracture healing and healing time was observed. RESULTS: All operations of two groups were successfully completed. The incisions healed by first intention, and no vascular/nerve injury or incision infection occurred. The operation time of group A was significantly longer than that of group B ( P<0.05). There was no significant difference in the intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing ( P>0.05). All patients were followed up 12-36 months (mean, 14.8 months). The VAS scores at 48 hours after operation were significantly lower than those before operation in the two groups ( P<0.05); there was no significant difference in the difference of pre- and post-operative VAS score between groups ( P>0.05). The AOFAS scores at 12 months after operation were significantly higher than those at 3 months after operation in the two groups ( P<0.05); and there was no significant difference between groups at 3 and 12 months ( P>0.05). X-ray films showed that the fractures of the two groups healed and there was no significant difference in healing time ( P>0.05). There was no significant difference in calcaneal length and width and Gissane angle between groups at each time point ( P>0.05), but there was significant difference in Böhler angle between groups at 12 months ( P<0.05). The imaging indexes of the two groups significantly improved at each time point after operation when compared with those before operation ( P<0.05). There was no significant difference between different time points after operation ( P>0.05) in the imaging indexes of group A. There were significant differences in the calcaneal length, calcaneal width, and Gissane angle of group B between 12 months and 1 day, 3 months after operation ( P<0.05), and there was no significant difference between 1 day and 3 months after operation ( P>0.05). The differences in Böhler angle of group B between different time points after operation were significant ( P<0.05). There was no significant difference between groups in the loss of all imaging indexes at 3 months after operation ( P>0.05). The losses of calcaneal width, Böhler angle, and Gissane angle in group A at 12 months after operation were significantly smaller than those in group B ( P<0.05), and there was no significant difference in the loss of calcaneus length between groups ( P>0.05). CONCLUSION: Compared with only minimally invasive plate fixation, the combination of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach for Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of less trauma, less incision complications, reliable fracture reduction and fixation, and good long-term stability. 目的: 探讨经跗骨窦入路微创钢板联合内侧支撑空心螺钉固定SandersⅡ、Ⅲ型跟骨骨折的疗效。. 方法: 回顾分析2016年3月—2021年3月符合选择标准的46例SandersⅡ、Ⅲ型跟骨骨折患者临床资料。其中，经跗骨窦入路微创钢板联合内侧支撑空心螺钉固定20例（A组），经跗骨窦入路单纯微创钢板固定26例（B组）。两组患者性别、年龄、致伤原因、骨折分型及侧别、受伤至手术时间，以及术前跟骨长度、跟骨宽度、Böhler角、Gissane角、疼痛视觉模拟评分（VAS）等一般资料比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、术中出血量、住院时间以及患足可完全负重时间；术前及术后48 h采用 VAS 评分评价患者疼痛改善情况，术后3、12个月采用美国矫形足踝协会（AOFAS）踝与后足评分评价关节功能；手术前后摄X线片，测量跟骨长度、跟骨宽度、Böhler角及Gissane角，计算上述指标术后3、12个月分别与术后1 d的差值（丢失值），评价其丢失程度；观察骨折愈合情况及愈合时间。. 结果: 两组手术均顺利完成，切口均Ⅰ期愈合，无血管神经损伤、切口感染等并发症发生。A组手术时间较B组延长，差异有统计学意义（ P<0.05）；两组术中出血量、住院时间以及患足可完全负重时间比较，差异均无统计学意义（ P>0.05）。两组患者均获随访，随访时间12～36个月，平均14.8个月。两组术后48 h VAS评分均较术前降低（ P<0.05）；组间手术前后VAS评分差值比较，差异无统计学意义（ P>0.05）。两组术后12个月AOFAS评分均高于术后3个月（ P<0.05）；组间术后3、12个月比较，差异均无统计学意义（ P>0.05）。X线片复查示，两组骨折均愈合且愈合时间差异无统计学意义（ P>0.05）。各时间点两组跟骨长度、跟骨宽度、Gissane 角差异均无统计学意义（ P>0.05），而Böhler角术后12个月组间比较差异有统计学意义（ P<0.05）。两组各影像学指标术后各时间点均较术前改善（ P<0.05）。A组各影像学指标术后各时间点间差异均无统计学意义（ P>0.05）；B组跟骨长度、跟骨宽度、Gissane 角术后12个月与术后1 d、3个月比较差异有统计学意义（ P<0.05），术后1 d、3个月间差异无统计学意义（ P>0.05）；Böhler角各时间点间比较差异均有统计学意义（ P<0.05）。A组术后3个月各影像学指标丢失程度与B组比较，差异均无统计学意义（ P>0.05）；A组术后12个月跟骨宽度、Böhler角、Gissane 角丢失程度较B组小（ P<0.05），跟骨长度丢失程度组间差异无统计学意义（ P>0.05）。. 结论: 与单纯微创钢板固定相比，经跗骨窦入路微创钢板联合内侧支撑空心螺钉固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折，具有创伤小、切口并发症少、骨折复位及固定可靠、远期稳定性好等优点。.

[Abstract] [Full Text] [Related] [New Search]