A Comparative Study Of Traditional Lateral Incision And Minimally Invasive Tarsal Sinus Combined With Lateral Small Incision In The Treatment Of Sanders ? And ? Intra-articular Calcaneal Fractures

Objective By comparing the previous lateral "L" incision with the transtarsal sinus combined lateral incision,the clinical efficacy and safety of internal fixation at the incision site for Sanders III and IV intra-articular calcaneal fractures were studied,so as to improve the choice of treatment methods for Sanders III and IV intra-articular calcaneal fractures by orthopaedic doctors.For reference.Methods From January 2014 to December 2017,Sanders III and IV intra-articular calcaneal fractures were treated with traditional lateral incision and transtarsal sinus incision combined with lateral minimally invasive plate fixation.According to the consensus diagnostic criteria,screening criteria and removal criteria,60 feet were collected and randomly divided into two groups.Group A was treated with traditional lateral incision(30 feet),group B with minimally invasive incision(30 feet),and group B with transtarsal sinus incision combined with lateral small incision.Open reduction and internal fixation.Each patient in the two groups was followed up for more than one year.The contents of the comparative study included: the waiting time before operation,the time needed for operation,the changes of Bohler angle,Gissane angle,calcaneal length and width,the complications of incision after operation,and the evaluation of foot function after one year.According to Maryland foot score.Through data collation,statistical analysis was carried out.Results All 60 patients were followed up for 12-14 months.After follow-up and statistical analysis of relevant data,in the treatment of intra-articular calcaneal fractures of Sanders III and IV,the traditional "L" incision internal fixation and minimally invasive incision internal fixation have satisfactory clinical effects.The preoperative waiting time of the traditional group was(6.81±1.42)days,that of the minimally invasive group was(4.73±1.43)days,that of the traditional group was(95.67±10.43)minutes,and that of the minimally invasive group was(79.12±5.32)minutes.There was significant difference between the two groups(p < 0.01).The height and width of calcaneus changed from preoperative(16.16°±3.04°)?(87.13°±3.43°)?(34.01±1.81)mm,(43.19±1.92)mm to postoperative(29.30°±2.95°)?(130.75°±2.71°)?(41.90±2.30)mm,(32.89±2.36)mm,respectively.The Bohler angle,Gissane angle and calcaneal angle in the minimally invasive group were lower than those in the control group.The values of bone height and width were changed from preoperative(16.05°±2.79°)?(88.89°±4.30°)?(33.90±2.98)mm,(44.02±2.36)mm to postoperative(29.18°±2.76°)?(128.27°±2.70°)?(41.37±2.93)mm,(34.02±3.11)mm,respectively.Gissane angle,calcaneal length and calcaneal width after operation were higher than those before operation,while calcaneal width was smaller than those before operation.The difference of these values before operation and after operation was statistically significant(p < 0.01).By comparing the two groups of incisions,we found that there were some differences in calcaneal imaging after operation(p < 0.01).There was no significant difference(p > 0.05),such as the changes of Bohler angle,calcaneal length and width,but Gissane angle had significant difference(p < 0.01).During the follow-up after operation,we found that there were 2 patients with superficial epidermal infection in the incision treated by traditional methods.There were 1 case of skin edge necrosis around the incision,2 cases of sural nerve injury,and 1 case of superficial epidermal infection at the incision treated by minimally invasive surgery.No other complications(skin edge necrosis,wound nonunion,sural nerve injury,etc.)were found.There were significant differences in incision complications between different incision methods(p < 0.01).According to Maryland foot scoring criteria,the function of foot in two groups after operation could be evaluated.It was found that there was no significant difference between the traditional group and the minimally invasive group(p = 0.901 > 0.05).Conclusions 1.two kinds of incision internal fixation methods can effectively treat SandersIII and IV type intra-articular calcaneal fractures.2.minimally invasive tarsal sinus combined with small lateral incision for the treatment of SandersIII and IV intra-articular fractures of the calcaneus is better than the traditional L shaped incision in the treatment of calcaneal fracture.It has the advantage of waiting time,short operation time,and less complications after operation.It is a kind of treatment for the closed fracture of SandersIII and IV type of calcaneus.Way.