Comparison of the efficacy of minimally invasive technique and open surgery in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures / 中华骨科杂志

ABSTRACT

Objective:To investigate the clinical effect of small incision in the sinus tarsal combined with internal fixation with hollow nails or small plates in the treatment of Sanders type II and III calcaneal fractures.Methods:A retrospective analysis of the relevant data of 50 patients with closed calcaneal fractures (sander II, III) were admitted and followed up from September 2015 to April 2017. According to different surgical methods, they were divided into two groups. Those who used a small incision of the sinus tarsal combined with hollow nail or small plate internal fixation were the minimally invasive group; those who used the traditional lateral "L" approach combined with the traditional plate internal fixation were the open group. There were 30 cases in the minimally invasive group, 20 males and 10 females; age 44.53±13.74 years (19 to 78 years); 20 cases in the open group, 13 males and 7 females; age 45.35±12.93 years (19 to 70 years old). The two groups of patients were treated with different methods for surgical treatment. During the operation, the calcaneal varus was corrected and the length, width, and height of the calcaneus were restored, but the fracture end was fixed in different ways. X-ray and CT examinations were performed before and after the operation to evaluate the type of fracture, reduction and fracture healing, the Bohler angle and Gissane angle at the last follow-up were measured, and postoperative complications were recorded. The Maryland foot scoring system was used to evaluate the clinical efficacy.Results:The difference in general information between the two groups of patients was not statistically significant and comparable. Patients in both groups were followed up for 16 months to 36 months, with an average of 21 months. In the minimally invasive group, 7 cases received allogeneic bone grafts, 17 cases were fixed with microplates, and 13 cases were fixed with hollow lag screws; 5 cases in the open group received allogeneic bone grafts, all of which were fixed with conventional lateral calcaneal plates. The intraoperative blood loss during operation in the minimally invasive group was 48.23±5.56 min, the open group was 54.25±5.09 min; the minimally invasive group was 53.10±8.5 ml, and the open group was 61.75±7.13 ml. The differences were statistically significant ( t=3.75 and 3.87, P<0.01). The fracture healing time of the minimally invasive group was 9.6±1.52 weeks, and that of the open group was (11.05±2.33) weeks. The difference between the two groups was statistically significant ( t=2.67, P<0.05). According to the Maryland score at the last follow-up, the excellent and good rate was 80.00% in the minimally invasive group and 50% in the open group. Postoperative imaging showed that the articular surface of the two groups after calcaneal surgery was collapsed and reset, the height, width and length of the calcaneus were restored, and the axis of the calcaneus was corrected. The Gissane angle and Bohler angle were significantly different from those before the operation (both P<0.001) , while Bohler angle in minimally invasive group (15.50°±4.18° vs 31.03°±3.35°, t=15.88), Gissane angle in minimally invasive group (101.87°±9.94° vs 129.17°±4.85°, t=13.52); Bohler angle in open group (15.00°±4.22° vs 30.75°±3.39°, t=13.02), and Gissane angle (104.75°±11.02° vs 128.6°±4.56°, t=8.95). There was no significant difference in the Gissane angle ( t=0.414, P=0.68) and Bohler angle ( t=0.292, P=0.77) between the two groups of patients. In the minimally invasive group, there was 1 case of traumatic arthritis and 1 case of superficial skin border infection, with a complication rate of 6.67%. In the open group, there was 2 cases of skin border necrosis secondary to deep infection, 3 cases of superficial skin border, 2 cases of infection and traumatic arthritis, and the complication rate was 35%. The difference in the overall complication rate between the two groups was statistically significant ( P=0.021). Conclusion:The treatment of calcaneal fractures with sinus tarsal incision plate or hollow screw internal fixation has the advantages of less trauma, reduction under direct vision, reliable reduction and fixation, and low complications. It is suitable for Sanders type II and III calcaneal fractures.