| Objective:Comparison Between Sinus Tarsi Approach and Extensile Lateral approach for Treatment of Sanders type ? and ? calcaneal fractures Methods:According to inclusion and exclusion criteria,all patients with calcaneal fracture treated by operation in our center from June 2015 to June 2018 were screened.A total of 87 patients(87 feet)were included in the study sample.According to the different approaches,the patients were randomly divided into control group(45 cases)via lateral L-shaped approach and observation group(42 cases)via transtarsal sinus approach.The general data of age,fracture classification and injury causes were compared between the two groups,and their comparability was analyzed.Preoperative routine limb elevation,oral or intravenous use of anti-swelling drugs,analgesic,cold compress and other treatments shorten the preoperative waiting time.No special method was used for reduction in both groups,locking titanium plate was used for fracture fixation without bone grafting,and negative pressure drainage was placed under deep fascia before closing the incision.The patients were treated with prophylactic antibiotics,intravenous or oral analgesics,and limb elevation.The preoperative waiting time,operation time,drainage volume,visual analogue scale(VAS),postoperative complications,calcaneal width,height,calcaneal tubercle joint angle(B hler angle,hereinafter referred to as B angle)and calcaneal cross angle(Gissane angle,hereinafter referred to as G angle)were recorded.The Maryland foot function score and visual simulation score of the last follow-up were recorded at 3months and the last follow-up after discharge.The data of the two groups were compared.Results:The average age of the observation group was 43.31±9.85 and that of the control group was 40.67±10.01.There were 33 males and 9 females in the observation group and 34 males and 11 females in the control group.There was no statistical difference between the two groups(P > 0.05).All patients reached the final follow-up standard.The observation group was followed up for 6 to 12 months,while the control group was followed up for 6 to 20 months.Bone healing was achieved in both groups.The waiting time before operation and the drainage volume after operation in the observation group were lower than those in the control group(p < 0.001),but there was no significant difference in the operation time between the two groups(P > 0.05).The imaging evaluation of the two groups showed that the height and width of G,B and calcaneus in the control group and the observation group were improved before andafter the operation,and the difference was statistically significant(p < 0.05).There was no significant difference between the two groups before and after operation in imaging indexes(P > 0.05).There was no significant difference in Maryland score,Maryland score and VAS score between the two groups at 3 months after operation,the last follow-up(P > 0.05).The VAS score of the observation group was 3.81±0.19)at 3days after operation,which was better than that of the control group(4.39±0.60),and the difference was statistically significant(p<0.05).The total incidence of complications was 9.52% in the observation group and 24.22% in the control group.There was no significant difference between the two groups.The incidence of incision complications was 2.38% in the observation group and 15.56% in the control group(P< 0.05).Conclusion:The effect of transtarsal sinus approach in the treatment of Sanders type II and III calcaneal fractures is exact.Postoperative functional and imaging evaluation is similar to that of the lateral L-shaped approach,but it is superior to the lateral L-shaped approach in shortening the preoperative waiting time,reducing the incision pain and the incidence of incision complications.However,there is no significant difference in the incidence of total complications between the two groups,and the former requires high surgical proficiency,and it is difficult to insert common anatomical plates. |
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