ABSTRACT
Objective To compare sinus tarsi approach(STA) and extensile L shape approach (ELA) in the surgical treatment of calcaneal fractures. Methods A total of 51 cases of calcaneal fractures treated from May 2014 to December 2016 were enrolled. Twenty of them were performed ORIF via the sinus tarsi approach, while the other 31 cases were performed ORIF via lateral extensile L shape approach. X-ray films were taken postoperatively to record the changes of B?hler angle and Gissane angle. The AOFAS, VAS and SF-36 scores were adopted to assess the therapeutic effect. Results The average follow-up period of STA group was 15.5 months. And patients in ELA group were followed up for an average period of 18.4 months. All the fractures in the series had a boney union at or before the final follow-up. The final correction of B?hler angle (34.60 ± 2.91)° , and Gissane angle (114.45 ± 2.91)° was significantly increased in the STA group; and the final correction of B?hler angle (33.55 ± 2.73)° , and Gissane angle (112.81 ± 4.15)° was also significantly increased in the ELA group; while there was no significant difference between the two groups. The final AOFAS scores , VAS scores and SF-36 scores of the STA were (83.56 ± 7.13), (1.78 ± 0.89), (88.95 ± 4.31) scores, while those in ELA group were (81.91 ± 9.89), (2.01 ± 1.33) and (86.65 ± 4.95) scores. There was no significant difference between the two groups (P>0.05). No wound problem happened in STA group, but there were 2 cases who had wound complications in ELA group. Conclusions No significant difference is found between the two groups in the short-term efficacy of the treatment for calaneal fracture. However, STA has the advantages of lower soft tissue complication rate.
ABSTRACT
Objective To compare the clinical efficacy of the nerve bow (digital nerve and cutaneous antebrachii later-als) with end-to-side neuroanastomosis and traditional end-to-end neuroanastomosis for repairing bilateral proper digital nerve inju-ries while replanting injured fingers. Methods A total of 57 patients with bilateral proper digital nerve injuries from March 2009 to September 2012 were retrospectively analyzed. The patients were divided into three groups according to different treatments:19 patients underwent nerve graft bow end-to-side neuroanastomosis. During operation, a cutaneous antebrachii laterals nerve was freed and obtained from the homolateral forearm, which were sutured with bilateral distal digital nerve end to end, then nerve bow was formed. The bilateral proximal ends of digital nerve were sutured end-to-side bow, respectively. 22 patients underwent digital nerve bow end-to-side neuroanastomosis. During operation, bilateral distal ends and proximal ends were sutured respectively;con-sequently, the distal and proximal nerve bows were formed. A cutaneous antebrachii laterals nerve was obtained from the homolat-eral forearm, then divided equally to 2 parts which were used to bridge the 2 nerve digital nerve bow end-to-side neuroanastomosis bows. 16 patients underwent nerve graft with end-to-end neuroanastomosis. The sensation of finger plup, two point discrimination and motion of joints were evaluated. Results All patients achieved primary healing of wound after operation, with 57 fingers re-covered uneventfully. In nerve graft bow end-to-side neuroanastomosis group, 18 patients were followed up for 3-15 months;the average result of sensation measurement was S3+;the average result of two point discrimination was 5.1±0.8 mm. In digital nerve bow end-to-side neuroanastomosis group, 19 patients were followed up for 4-15 months;the average result of sensation measure-ment was S3; the average result of two point discrimination was 6.3 ± 0.9 mm. In nerve graft with end-to-end neuroanastomosis group, 12 patients were followed up for 3-14 months;the average result of sensation measurement was S2, the average result of two point discrimination was 7.2±1.4 mm. According to total active motion scales, there had no difference in results of motion of joints in the 3 groups. Conclusion The nerve bow end-to-side neuroanastomosis is valuable method for repairing bilateral proper digi-tal nerve injuries at the same time, which can restore sensation of fingers.