Objective: ?To discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision.
Methods: ?A retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated.
Results: ?Sixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the implants in the extensile incision group. The bone healing time was (9.9±0.8) weeks in the minimally invasive group, and was (10.1±0.7) weeks in the extensile incision group, showing no significant difference (t=0.613, P=0.845 ). Böhler angle, Gissane angle, calcaneal varus angle, AOFAS score, and VAS score were significantly improved at last follow-up when compared with preoperative values in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05), and the corrective value of angle showed no significant difference between 2 groups (P>0.05).
Conclusions: ?Limited open reduction via sinus tarsi approach for intra-articular calcaneus fractures could reduce the incidence of wound complications effectively. Meanwhile, the medial distraction technique is helpful to correct the heel varus deformity.
目的: 比较内侧撑开技术联合跗骨窦切口与外侧L形切口治疗跟骨关节内骨折的临床疗效。.
方法: 回顾分析2013年4月-2014年11月采用内侧撑开技术联合跗骨窦切口治疗跟骨关节内骨折的21例患者资料（微创组），并与2012年6月-2014年9月采用外侧扩大L形切口治疗的32例跟骨关节内骨折患者（切开组）进行对照研究。两组患者性别、年龄、致伤原因、骨折分型、伤后至手术时间及术前Böhler角、Gissane角、跟骨内翻角、美国矫形足踝协会（AOFAS）踝与后足评分、疼痛视觉模拟评分（VAS）等一般资料比较差异均无统计学意义（P>0.05），具有可比性。记录两组患者手术时间、术后伤口并发症及骨愈合时间。手术前后采用AOFAS踝与后足评分及VAS评分评价疗效。于X线片上测量Böhler角、Gissane角和跟骨内翻角，并计算手术前后改善值。.
结果: ?术后共39例患者获随访，微创组16例随访时间6～18个月，平均11.5个月；切开组23例随访时间6～24个月，平均13.5个月。两组手术时间比较差异无统计学意义（t=0.929，P=0.796）。微创组术后未出现伤口裂开、感染等并发症；切开组3例患者出现伤口周围皮缘坏死，经换药3周后治愈。末次随访时两组患者均未出现内固定物松动或复位丢失。微创组1例出现距下关节活动僵硬，切开组4例出现不同程度距下关节活动僵硬、1例出现内固定不适，均未行二期手术治疗。两组患者均获骨性愈合，微创组及切开组愈合时间分别为（9.9±0.8）周和（10.1±0.7）周，差异无统计学意义（t=0.613，P=0.845）。末次随访时，两组患者Böhler角、Gissane角、跟骨内翻角、AOFAS踝与后足评分及VAS评分均较术前显著改善（P<0.05）；末次随访时两组间比较上述指标差异均无统计学意义（P>0.05）；两组间比较Böhler角、Gissane角、跟骨内翻角改善值，差异亦无统计学意义（P>0.05）。.
结论: 内侧撑开技术联合跗骨窦切口治疗跟骨关节内骨折可有效降低手术伤口并发症发生率，同时有助于纠正跟骨内翻畸?形。.
Keywords: Intra-articular calcaneus fracture; Lateral extensile approach; Minimally invasive surgery; Sinus tarsi approach.