| Objective:Calcaneal fracture is the most common tarsal fracture.In recent years,the treatment of Sanders type II calcaneal fracture with small incision of tarsal sinus has gradually become a consensus,and the study of small incision of tarsal sinus has gradually become a hot spot.The screw placement after reduction of calcaneal fracture through the small incision of tarsal sinus belongs to closed fixation,which depends on the clinical experience of the operator,and most of the screw placement direction,position and depth need repeated perspective,which not only affects the surgical effect.It also increased the operation time,the number of intraoperative fluoroscopy and the dose of radiation exposure for doctors and patients.In this study,a new 3D printing and navigation template was designed to assist in the accurate placement of calcaneal screw,and the clinical effect of this template in the treatment of Sanders type Ⅱ calcaneal fracture was discussed.Methods:Fifty patients with Sanders type Ⅱ calcaneal fracture admitted to our hospital from October 2015 to August 2017 were collected,including 21 cases of simple left injury,26 cases of simple right injury and 3 cases of bilateral injury(only one side met the standard and 2 cases on the left side.1 case on the right side,including 48 males and 2 females;The age is between 35 and 65 years old,with an average age of 48 years.The patients were randomly divided into guide plate group(group A,n=25)and non-guide plate group(group B,n=25).The guide plate group(group A)was treated with 3D printing navigation template assisted screw placement,and the non-guide plate group(group B)was treated with simple screw placement.The patients in the two groups were treated with tarsal sinus incision to analyze whether there were differences in surgical effect(Bohler angle,Gissane angle,calcaneal width,AOFAS score),operation time and intraoperative fluoroscopy times between the two groups.Results:All the 50 patients were followed up,the average follow-up time was 3 times 9 months.According to the standard of foot and ankle joint score(AOFAS score)of American Association of foot and ankle surgery,group A(guide plate group)was excellent in 10 feet,good in 12 feet and poor in 3 feet.The excellent and good rate was 88%.Group B(non-guide plate group)was excellent in 7 feet,good in 14 feet and poor in 4 feet.The excellent and good rate was 84%.There were significant differences in Bohler angle,Gissane angle and calcaneal width between group A(guide plate group)and group B(non-guide plate group).The Bohler angle of group A(guide plate group)was(27.00±5.00 °).The postoperative Gissane angle(128.72±4.85°)and calcaneal width(30.08±1.58 mm),)AOFAS score(84.24±8.26)were significantly higher than those in group B(non-guide plate group)(27.88±4.71°)and Gissane angle(129.84±5.62°).There was no significant difference in calcaneal width(29.60±2.24 mm),)with AOFAS score(84.92±9.20).In group A(guide plate group),the operation time(63.60=4.72min),the number of intraoperative fluoroscopy(2.722±0.61 times)and the operation time in group B(non-guide plate group)were(63.6±4.72min),(2.72±0.61)and(94.72±7.60min),respectively.There was significant difference in the number of intraoperative fluoroscopy(6.52 ±0.92),and the difference was statistically significant.Conclusion:The application of 3D print navigation template in the treatment of Sanders type Ⅱ calcaneal fracture can achieve the purpose of screw placement,save operation time,reduce the radiation exposure dose of doctors and patients during operation,which is a kind of surgical method in accordance with the modern minimally invasive precision concept. |
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