| Backgroud:The calcaneus is one of the most important weight-bearing bones,which plays an important role in maintaining balance and movement of the human body.Improper treatment of calcaneal fractures involving the calcaneal-talar joint can seriously affect the function of the lower limbs.For Sanders Ⅱ and Ⅲ calcaneal fractures,open reduction with the lateral L-shaped incision of the calcaneus is considered the "gold standard operation".This surgical method has a good surgical field of vision and is convenient for implantation and reliable internal fixation.However,this surgical method can be accompanied by serious soft tissue complications and affect the treatment effect.C-arm guided closed reduction and hollow lag screw fixation,as a minimally invasive surgical method for the treatment of calcaneal fractures,can be used to treat Sanders Ⅱ and Ⅲ calcaneal fractures.It has little soft tissue trauma and theoretically can reduce soft tissue complications,but it is not clear whether it can achieve the same clinical effect as the lateral L-shaped incision open reduction of the calcaneus in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Objective: This study intends to compare the efficacy and surgical complications of C-arm guidance closed reduction and hollow lag screw fixation and open reduction/internal fixation with L-shaped incision on the lateral side of the calcaneus in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures,and comprehensively evaluates the advantages and disadvantages of C-arm guided closed reduction and hollow lag screw fixation,and hoped to provide a reference for orthopedic physicians to choose better treatment options for Sanders Ⅱ and Ⅲ calcaneal fractures.Method: The Sanders type Ⅱ and Ⅲ closed calcaneal fracture cases treated by the First People’s Hospital of Huaihua City were collected and screened according to the inclusion and exclusion criteria.Patients who underwent C-arm guidance closed reduction and hollow lag screw fixation were set as the closed reduction group.Patients with open reduction and internal fixation were set as the open reduction group.The general information and condition assessment data of the two groups of patients were analyzed by homogeneity,and the operation time,blood loss,hospitalization time,and soft tissue complication rate of the two groups were compared and analyzed.In addition,postoperative imaging index(postoperative width,height,Gissane angle,B(?)hler angle of calcaneus)and Maryland score of the two groups were compared and analyzed to value the short-term clinical efficacy.Result: There was no statistically significant difference in general information and disease assessment data between the closed reduction group(20 cases)and the open reduction group(21 cases)(P > 0.05),and the two groups were comparable.The postoperative calcaneal height and B(?)hler angle in the two groups were greater than that of before operation(P < 0.05).The postoperative width and Gissane angle were less than that of before operation(P < 0.05).There was no statistically significant difference between the two groups in postoperative calcaneal width,height,Gissane angle,B(?)hler angle,and Maryland score(P > 0.05).However,the preoperative hospital stay,operation time,postoperative hospital stay,total hospital stay,intraoperative blood loss,and postoperative soft tissue complications rate of the closed reduction group were significantly lower than that of the open reduction group(P < 0.05).Conclusion: C-arm guided closed reduction cannulated lag screw fixation is an effective method for the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Its short-term effect is equivalent to that of open reduction and internal fixation with an L-shaped incision on the lateral side of the calcaneus.In addition,this surgical method can avoid a wide range of soft tissue damage,with few soft tissue complications and quick recovery.It is a minimally invasive treatment with good curative effect and is worthy of being applied to Sanders Ⅱ and Ⅲ calcaneal fractures. |
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