[Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture].

OBJECTIVE: To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture. METHODS: Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared. RESULTS: Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05). CONCLUSION: Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

[Spinal pedicle screw internal fixation through endoscope-assisted posterior approach for treatment of traumatic atlantoaxial instability].

OBJECTIVE: To explore the feasibility and effectiveness of spinal pedicle screw internal fixation through endoscope-assisted posterior approach for the treatment of traumatic atlantoaxial instability. METHODS: Between September 2008 and September 2010, 44 patients with traumatic atlantoaxial instability received spinal pedicle screw internal fixation through endoscope-assisted posterior operation (micro-invasive surgical therapy group, n=22) or traditional surgical therapy (control group, n=22). There was no significant difference in gender, age, type of injury, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between 2 groups (P > 0.05). The blood loss, operation time, length of the incision, improvement rate of JOA, and graft fusion rates were compared between 2 groups to assess the clinical outcomes. RESULTS: The blood loss, operation time, and length of the incision in the micro-invasive surgical therapy group were better than those in control group (P < 0.05). All incisions were primary healing. Of 88 pedicle screws, 7 pedicle screws penetrated into the interior walls of cervical transverse foramen in the micro-invasive surgical therapy group and 8 in the control group, but there was no syndrome of vertebral artery injury. All patients of the 2 groups were followed up 12 to 37 months (mean, 26 months). Bony fusion was achieved in all cases within 3 to 12 months (mean, 5.3 months). No loosening or breakage of screw occurred. At 6 months to 1 year after operation, the internal fixator was removed in 6 cases and the function of head and neck rotary movement were almost renewed. The JOA score was significantly improved at last follow-up when compared with preoperative score (P < 0.05), and no significant difference in JOA score and improvement rate between the 2 groups at last follow-up (P > 0.05). CONCLUSION: The micro-invasive surgical therapy can acquire the same effectiveness to the traditional surgical therapy in immediate recovery of stability, high graft fusion rate, and less complication. Moreover, it can significantly reduce the operation time, blood loss, and soft tissue injury, so this approach may be an ideal way of internal fixation to treat traumatic atlantoaxial instability.