| Background:Calcaneal fracture is a common orthopaedic disease in foot trauma.The complex anatomy of calcaneus,trauma mechanism and fracture types,covering local soft tissue,which can cause heel persistent pain,subtalar joint stiffness,severe disability and other sequelae.Diagnosis is usually made by X-ray,but more accurately by a computed tomography(CT)scan and three-dimensional(3D)reconstruction.In the last years,much has been known regarding its physiopathology and osteosynthesis.Open reduction and internal fixation is widely accepted,while its incision complications also become a big problem.Nowadays,with the new developments in osteosynthesis materials have been made and minimally invasive technique,less invasive surgery is very important for reduction accuracy and soft-tissue damage avoidance,which shows promising prospect.Objective :To compare and analyze the curative effect of minimal incision and L shape incision with internal fixation in treatment of closed calcaneal fractures.Methods: From Junary 2015 to Junary 2016,60 cases of closed calcaneal fractures sought for treatment in the third affiliated hospital of shihezi university.The patients were divided into two groups according to random number table : minimal invasive group(n=30)and conventional group(n=30).The patients in minimal invasive group were performed a limited open reduction and internal fixation(ORIF)via asinus tarsi incision combine with longitudinal incision,while others in conventional group were performed ORIF via a classical lateral extensile L-shape approach.The preoperative waiting timeoperation time,changes of B?hler angle and Gissane angle before and after treatment,incision complications were recorded in time.The final curativeeffect was comprensively assessed according to the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society(AOFAS).We compared the observation indicators in each group by using statistical analysis,taking ?=0.05 as theinspection level,P<0.05 had a siginficant differences.Results: All cases were followed up for an average of 10-14 months.The time from the injury tosurgery,operative time and in the minimal invasive group were(6.17±1.02)days?(84.57±2.88)min,and these in the conventional group were(9.43±1.10)days?(102.70±15.96)min,also there was significant difference between the two groups(P<0.001).Before the operation,the immediate correction of B?hler angle,Gissane angle,calcaneal length and calcaneal width in the minimal invasive group were(13.37°±3.89°)?(100.81°±6.42°)?(50.53±2.57)mm?(43.23±2.71)mm,and after the operation,these were changed into(29.27 °±5.73°)?(124.75°±5.37°)?(62.87±2.16)mm?(34.30±2.04)mm.In the conventional group,those outcome measures before the operation were(13.37°±3.89°)?(100.81°±6.42°)?(50.53±2.57)mm,and these changed int[(27.55°±5.15°)?(122.68°±4.79°)?(62.40±1.75)mm?(34.70±2.42)mm.For each group,these changes of outcome measures before and after surgery were significantly in the normal range and there was significant difference(P<0.001),but there was no significant difference between the two groups in the B?hler angle,Gissane angle,calcaneal length and calcaneal width after the treatment(P>0.05).No wound problem happened in the minimal invasive group,2 case of skin necrosis,2case of skin infiection,1cases of sural nerve injury were found in the conventional group,while there was significant difference between the two groups(P<0.05).The AOFAS score(including individual domain scores)in minimal invasive group were higher than those in conventional group,but there was no significant difference(P>0.05).Conclusion: Limited ORIF via a sinus tarsi incision combine with longitudinal incision have the familiar therapeutic effects to ORIF via a conventional extensile L shape incision in the management of calcaneal fractures.But the former has the advantage of lower preoperative waiting time,shorter operative time and lower incision complication rate,which is a effective and practial operation technology in the treatment of calcaneal fracture. |
PDF Full Text Request