To Study The Trement Using The Sinus Tarsi Approach In Sanders Ⅱ Ⅲ Calcanal Fractures

Objective:To investigate the clinical effects using the sinus tarsi approach in the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ.Methods:From September 2011 to December 2014,102 patients with calcaneal fractures of sanders type Ⅱ and III were treated. All these patients were divided into 2 groups:minimal invasive group (n= 53) and standard group (n= 49).75 feet were Sanders type Ⅱ and 27 feet were Sanders type Ⅲ. There were 40 Sanders type II and 13 Sanders type Ⅲ in minimal invasive group, and 35 Sanders type II and 14 Sanders type Ⅲ in standard group. Total hospitalization expenditures as well as the duration of hospitalization, duration of surgery, the height and width of calcaneus, Bohler angle and Gissane angle before and after operation were compared between two groups. VAS score was measured in three days after operation. Results were evaluated clinically using the AOFAS ankle hind foot scale and Maryland foot score system after 3,6 and 12 months of surgery.Results:Patients of both groups were followed up for 13-25 months with average of 15.8 months. All the fractures showed bone union with good functional recovery. According to the preoperative data, there was no significant statistical difference on sex, age, BMI and in Sanders type between both groups. In the minimally invasive group the preoperative and postoperative hospital stay, operative time and the total hospital expenditure are lesser than in standard group, with statistical significance of P<0.05. There was no significant statistical difference (P>0.05) on postoperative calcaneal height and width, Bohler and Gissane angle when compared between above motioned two groups. On the first day after operation, the VAS score of the minimal invasive group and standard group were (8.51±0.42) and (8.67±0.37), it was statistically significant (P<0.05). There was no any significant difference on AOFAS ankle hind foot score and Maryland foot score on 6 and 12 months after operation, but the scores on 3 months after operation shows minimal invasive group were better than standard group, with statistically significance (P<0.05). The number of patients with complications in both groups was statistically significant (P<0.05). One year after surgery, collected data shows that there was excellent outcome of 88.68% in the minimal invasive group which was better than standard group 73.47%, with statistically significance (P<0.05).Conclusion:The tarsal sinus minimally invasive approach for the treatment of calcaneal fractures with Kirschner wire is safe and reliable. Duration of surgery, duration of hospitalization, total hospitalization expenditures, early ankle hind foot scale, complications after surgery, outcome and VAS score in this minimally-invasive approach were better than those in ORIF with plates.