The Clinical Comparative Study Of Sanders Ⅱ And Ⅲ Calcaneal Fractures Treated With Small Plate Fixation Via Tarsal Sinus Approach

Background The calcaneal fracture is frequently occurring disease in clinic.Previously,"L" incision steel plate was used for fixation.However,there are risks of soft tissue infection and skin necrosis.With the continuous innovation of minimally invasive concept,minimally invasive treatment for such fractures is a hot issue in clinical practice.Objective In this study,the Sanders Ⅱ and Ⅲ calcaneal fractures were treated with small plate fixation via tarsal sinus approach and percutaneous prying reduction screw internal fixation.At the same time,the effect of three different surgical methods in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures was compared with the lateral traditional "L" incision plate fixation as a controlMethods This is a retrospective case control study,171 cases of Sanders Ⅱ and Ⅲ calcaneal fractures admitted to our orthopaedic department from January 2016 to October2020.The general data of patients were collected,including the name,the gender,the height,the weight,the body mass index(BMI),the injury leg,the injury factors and the surgical methods.171 patients with Sanders Ⅱ and Ⅲ calcaneal fractures were divided into three groups according to the operation method: in the group A,60 patients were treated with traditional lateral "L" incision plate fixation;in the group B,56 patients were treated with small plate fixation through tarsal sinus approach;in the group C,55 patients were treated with percutaneous reduction and screw fixation.The waiting time before operation,the operation time,the intraoperative blood loss and the hospitalization time of patients in each group were statistically compared;The visual analogue scale(VAS)of pain before surgery and 1,2,3,7 and 30 days after surgery was collected;The Bohler angle and the Gissane angle before operation and 1 day,1 month,3 months,6 months and 1 year after operation was collected;The postoperative imaging axial articular surface flatness;The incidence of postoperative complications such as the skin infection,the skin necrosis,the ibular impingement,the sural nerve symptoms and the arthritis was collected;The AOFAS ankle hindfoot score of foot function of patients after operation was used to evaluated the function of the foot.Results(1)A total of 171 patients were enrolled.According to the calculation results of the software G-Power 3.1,the sample size met the number requirements of the retrospective case-control study scheme.(2)The comparison of general data of patients in the group A,the group B and the group C were not statistically significant(P>0.05).(3)The waiting time before operation,the operation time and the hospital stay time in the group A were significantly longer than those in the group B and C(P=0.000),However there was no significant difference between the group B and the group C(P>0.05).The intraoperative blood loss in the group A was significantly more than that in the group B and the group C(P=0.000),and the intraoperative blood flow in the group B was more than that in the group C(P=0.000).(4)In the comparison of VAS pain scores of the 1,2,3 and 7 days after operation,the group A was significantly worse than the group B and the group C(P<0.05).However,there was no significant difference in the group B and the group C(P>0.05).(5)There was no significant difference in the Bohler angle and the Gissane angle among the three groups before operation(P>0.05);However,the Bohler angle in the group A and the group B was better than that of the group C at 1 day,1 month,3 months,6 months and 1year after operation(P<0.05).The Gissane angle in the group A was better than that in the group C at 1 day,1 month,3 months,6 months and 1 year after operation(P<0.05).There was no significant difference in the Bohler angle and the Gissane angle between the group A and the group B(P>0.05).(6)According to the flatness of calcaneal joint surface in X-ray axial position after removal of internal fixation after operation,the flatness of joint surface in the group A and the group B was better than that in the group C(P<0.05).(7)The postoperative complications including superficial skin infection,deep skin infection,skin necrosis,fibular impaction,neurological symptoms and arthritis in the group A were worse than those in the group B and the group C(P<0.05).(8)There was no significant difference in the AOFAS ankle hindfoot score of the three groups(P>0.05).Conclusion:(1)The traditional "L" incision plate fixation,the tarsal sinus approach small plate fixation,and the percutaneous prying reduction with screw internal fixation are all effective surgical methods for calcaneal fracture,they have their own advantages and disadvantages..(2)The tarsal sinus approach small plate fixation has the advantages of the less trauma,the less intraoperative bleeding,the fewer complications,and the shorter hospital stay.The tarsal sinus approach small plate fixation can complete the reduction of calcaneus shape and subtalar joint through limited incision to achieve more satisfactory clinical effect.