Safety Assessment Of Patellofemoral Plus Internal Fixation And Open Reduction And Internal Fixation For The Treatment Of Sanders Ⅱ~Type Ⅲ Calcaneal Fracture

ObjectiveTo evaluate the efficacy and safety of reduction and internal fixation with leverage,manipulation and open reduction and internal fixation in the treatment of Sanders Ⅱ ~ type Ⅲ calcaneal fracture,and to provide scientific guidance for the clinical treatment of calcaneal fracture.Method144 patients who diagnosed with unilateral Sanders Ⅱ ~ type Ⅲ calcaneal fractures and presented in PLA 91 st Central hospital(from June 2016 to June 2018).These patients were all met inclusion and exclusion criteria and they were retrospectively studied.Among these patients,72 patients who underwent open reduction and internal fixation with plates and screws were regarded as control group,while 72 patients who underwent prying and technique reduction and internal fixation were regarded as experimental group.Retrospective comparative study and analysis were conducted to compare the surgical indicators,rehabilitation effect of foot function,X-ray examination indicators,complications and quality of life scores of patients between the two groups,and to comprehensively evaluate the clinical application effect and safety of the two surgical methods.Results(1)Comparison of surgical indicators: the operation time,hospitalization time and fracture healing time in the study group were shorter than those in the reference group,and the intraoperative blood loss and hospitalization cost were less than those in the reference group,with significant differences(P < 0.05).(2)comparison of foot functional rehabilitation effect: 1 week and 6 months after surgery,the excellent and good efficacy rate(88.89%,87.50%)in the study group was similar to that in the control group(83.33%,83.33%),and the difference was not statistically significant(P> 0.05).(3)comparison of X-ray examination indexes: before surgery,there were no statistically significant differences in calcaneal height,calcaneal width,BOhler Angle and Gissane Angle between the two groups(P> 0.05).At 1 week and 6 months after surgery,the height of calcaneus increased and the width of calcaneus decreased in the two groups.BOhler Angle and Gissane Angle were both smaller,and the differences were significant compared with those before surgery(P< 0.05).However,there was no significant difference between the two groups(P> 0.05).(4)comparison of complications: the incidence of complications in the study group(1.39%)was lower than that in the study group(12.50%),with a significant difference(P< 0.05).The complications in both groups were treated symptomatically and improved within one week.(5)before surgery,gqoli-74 scores of the two groups were similar,and the difference was not statistically significant(P> 0.05).GQOLI-74 score of the study group 1 week after surgery was higher than that of the control group,with a significant difference(P< 0.05).ConclusionThe treatment of Sanders type II~III calcaneal fracture by prying and manipulative reduction and internal fixation can not only ensure the short-term and long-term rehabilitation of foot function and reduction of calcaneal anatomical structure,but also optimize the operation index,reduce surgical trauma,reduce hospital expenses,reduce complications and have higher clinical safety.Its application value is better than open reduction and plate fixation.It can be widely used in the treatment of calcaneal fracture.