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Effectiveness analysis of modified tarsal sinus approach for SandersⅡ-Ⅲ type calcaneal fractures

ObjectiveTo investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures.MethodsBetween January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative Böhler angle, Gissane angle, visual analogue scale (VAS) core (P>0.05), which were comparable. The operation time, postoperative drainage volume, postoperative Böhler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness.ResultsAll the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups (P>0.05). Patients in both groups were followed up 12-36 months (mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups (t=0.30, P=0.77). The postoperative Böhler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation (P<0.05); however, there was no significant difference in Böhler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation (P>0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups (P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation (P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation (t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group (t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups (χ2=1.98, P=0.16).ConclusionThe modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.

跟骨骨折切开复位内固定术后切口并发症分析

目的 总结预防跟骨骨折切开复位内固定术后切口并发症的方法。 方法 回顾分析2004 年8 月－2008 年4 月收治的56 例64 侧跟骨关节内骨折患者临床资料。其中男41 例，女15 例；年龄21 ～ 62 岁，平均36 岁。单侧48 例，双侧8 例。按Sanders 分型：Ⅱ型18 侧，Ⅲ型43 侧，Ⅳ型3 侧。受伤至手术时间3 h ～ 14 d，平均7.5 d。行跟骨骨折切开复位钢板内固定术，观察术后切口并发症发生情况。 结果 术后8 例11 侧发生局部切口并发症，发生率为17.2%，其中伤口乙级愈合9 侧，丙级愈合2 侧。11 侧中切口裂开6 侧，局部皮肤坏死3 侧，发生感染2 侧。分析原因发现4 侧为未待水肿明显消退即进行手术；3 侧为手术时间gt;2 h；2 侧为医生对手术入路解剖不完全熟悉、术中对皮瓣保护意识不强所致；2 侧原因不明，可能与术后过早拔除引流有关。余53 侧切口均甲级愈合。 结论 骨折后待皮肤皱褶征阳性再行手术、缩短手术时间及止血带使用时间、熟悉手术入路的解剖特点、熟练掌握全层切开皮肤和“不接触”皮肤保护技术、锐性分离皮瓣方法及术后恰当处理是预防切口并发症的有效途径。

DISTALLY-BASED SURAL MUSCULOCUTANEOUS FLAP FOR CHRONIC CALCANEAL OSTEOMYELITIS

Objective To investigate the clinical significance of the distally-based sural musculocutaneous flap for the treatment of chronic calcaneal osteomyelitis. Methods From January 2002 to October 2005, 7 patients (4 males, 3 females; age range, 15-68 years ) were treated with the distallybased sural musculocutaneous flap, who had chronic calcanealosteomyelitis after calcaneal fracture. After the radical debridement for all the nonviable and poorly vascularized tissues, all the chronic calcaneal osteomyelitis patients, who had suffered from open calcaneal fracture or closed calcaneal fracture, were treated with the open reduction, the internal fixation, and thebone graft. The ulcer lasted for 3-12 months before diagnosis of osteomyelitis. The musculocutaneous flaps ranged in size from 8 cm×4 cm to 12 cm×7 cmand the muscle flaps ranged from 4 cm×3 cm to 6 cm×5 cm. The donor defects were closed primarily in 5 patients and were resurfaced with the splitthicknessskin graft in 2 patients. Results All the musculocutaneous flaps survived completely and all the wounds healed smoothly. All the patients followed up for 2-6 months had no recurrence of osteomyelitis or return to their preoperative ambulatory status.Conclusion It is feasible to use the distallybased sural musculocutaneous flap for treatment of chronic calcaneal osteomyelitis.

SUBTALAR ARTHRODESIS AND CALCANEAL THALAMUS RECONSTRUCTION FOR MALUNION OF CALCANEAL FRACTURES

Objective To evaluate the clinical results of subtalar arthrodesis and calcaneal thalamus reconstruction for malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From December 1994 to January 2006, 84 cases(96 feet) of malunion of calcaneal fractures were treated with subtalar arthrodesis and calcaneal thalamus reconstruction. The L-shaped approach lateral to calcaneus was used. The bone autograft was harvested from iliac crest. Fiftyone cases were male and 33 cases were female, aging from 21 to 58 years (mean 385 years).One side was in volved in 72 cases and two sides in 12 cases. The injury was caused by falling from height in 57 cases, by traffic accident in 22 cases and other in 5 cases. It was 6-31 months from injury to operation (mean 9.5 months). Results Among the patients, all cases were followed up 1 to 132 months. The total excellent and good rate was 87.5%, including excellent in 31 feet, good in 53 feet and fair in 12 feet,according to Hindfoot scores system (American Orthopaedics Foot and Ankle Society). The B[AKo¨]hler’s and Gissane’s angles, the height of calcaneal thalamus and width of calcaneus were significant different from those of preoperation (Plt;0.01). Conclusion The treatment by bone autograft combined with subtalar arthrodesis and calcaneal thalamus reconstruction is an effective operation for malunion of calcaneal fractures, with advantages of correcting deformity, restoring the function of indfoot and relieving the pain of walking.

跟骨骨折术后骨髓炎临床分析

【摘要】目的 探讨跟骨骨折术后骨髓炎的治疗及影响因素。方法 1997年5月-2008年6月收治跟骨骨折术后骨髓炎47例, 所有患者均获随访,随访时间1～7年,平均3.7年。结果 按照CreightonNebraska 跟骨骨折疗效评价标准,优良率872%。结论 彻底清除病灶,选择合适皮瓣无张力修复创面可以缩短病程,提高疗效。

自固化磷酸钙人工骨在跟骨骨折治疗中的应用

腓肠神经筋膜蒂岛状皮瓣修复跟骨骨折皮肤缺损合并感染

目的 总结应用腓肠神经筋膜蒂岛状皮瓣修复感染性跟骨骨折合并皮肤缺损临床应用的可靠性。 方法 1999年7月～2002年12月，应用腓肠神经筋膜蒂岛状皮瓣一期修复感染性跟骨骨折合并皮肤缺损30例，男28例，女2例。年龄18～59岁。车祸伤19例，重物砸伤6例，利物刺伤5例。皮肤缺损范围5 cm×5 cm～10 cm×10 cm，伤后至手术时间48 h～8个月。根据缺损范围设计岛状筋膜蒂皮瓣移位于跟骨处，切取皮瓣范围6 cm×6 cm～11 cm×11 cm。 结果 术后移位皮瓣均成活，创口Ⅰ期愈合，随访12～36个月，平均18个月。足部皮瓣血循好，质地良好，皮瓣两点辨别觉为10～16 mm，平均14.5 mm。皮瓣无溃疡，踝关节功能良好，行走步态良好，无疼痛，外形恢复满意。 结论 腓肠神经筋膜蒂岛状皮瓣血管供应好，质地优良耐磨，手术操作简便，不牺牲主要血管，且有较强的抗感染能力，不仅可修复足跟、踝关节周围的皮肤缺损，还能修复小腿前侧的皮肤缺损，利用双腿交叉修复对侧小腿及足跟足踝部皮肤缺损，值得推广。

Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique

ObjectiveTo investigate the effectiveness of simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique.MethodsBetween January 2014 and August 2020, 6 cases of traumatic calcaneal osteomyelitis with defect deformities were treated by simultaneous treatment of near-arc bone transport by Ilizarov technique. The patients were all male; aged from 40 to 61 years (mean, 49.3 years). The disease duration was 2-72 months, with an average of 16.1 months. All patients were traumatic calcaneal osteomyelitis, including 4 cases of falling from height, 1 case of traffic accident injury, and 1 case of crushing injury. The infection affected the talar-heel joint in 4 cases, and the talar-heel joint was fused or partially fused in 2 cases. After the external fixator was removed, the Maryland foot scoring system was used to evaluate the foot function, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot function scoring system was used to evaluate the ankle-hindfoot function, and were compared with the preoperative scores.ResultsAll patients were followed up 1.5-26.0 months, with an average of 16.3 months. All incisions healed by first intention, no recurrence of infection occurred, and no surgical intervention such as second-stage bone grafting and fusion was performed. Five cases of calcaneal osteomyelitis with defect deformity underwent one-stage osteotomy and slipped, 1 case of the original bone mass after debridement after infection of calcaneal fractures slipped directly. The bone sliding time was 28-62 days, with an average of 38.7 days; the sliding distance was 3.1-5.2 cm, with an average of 3.6 cm. In 1 patient, due to the short follow-up time, the calcaneal slip bone had not healed, the external fixator had not been removed (not involved in clinical scoring), but the foot shape, reexamination of X-ray films and with frame walking were satisfactory. The time with external fixator was 6-8 months, with an average of 6.5 months in the other 5 cases. After removing the external fixator, the foot returned to three-point weight-bearing, and the longitudinal arch was recovered to varying degrees, and there was no obvious varus valgus. The Maryland score after removal of the external fixator was 80.8±4.7, which was significantly higher than that before operation (33.6±4.3) (t=–35.782, P=0.000), 3 cases were excellent and 2 cases were good; the median AOFAS ankle-hindfoot score was 84, the interquartile range was (79, 86), which was significantly improved when compared with the preoperative score [the median score was 33.5, the interquartile range was (21.3, 37.5)] (Z=–2.023, P=0.043), 4 cases were excellent and 1 case was good. Among them, pain, walking distance, getting rid of walking aids, going up and down stairs, deformity, etc. were significantly improved when compared with preoperative ones. Mobility such as subtalar and hock joints were poor or disappeared.ConclusionSimultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique can optimize the operation method, reduce the number of operations, and try to simulate the original shape of the calcaneus. It is an effective, economical, and novel treatment method.

Short-term effectiveness of TiRobot combined with O-arm navigation system in minimally invasive treatment of hindfoot fracture

Objective To investigate the short-term effectiveness of TiRobot combined with O-arm navigation system in the minimally invasive treatment of hindfoot fracture. Methods Between March 2019 and March 2021, 25 patients with hindfoot fractures were admitted. There were 14 males and 11 females, with an average age of 51.7 years (range, 19-76 years). The causes of injuries included falling from height in 17 cases and traffic accident in 8 cases. The interval between injury and operation was 1-3 days (mean, 2.1 days). There were 16 cases of calcaneus fracture, 7 cases of talus fracture, and 2 cases of calcaneus and talus fractures. According to Sanders classification criteria, the calcaneus fractures were classified as type Ⅱ in 10 cases and type Ⅲ in 8 cases; according to the Hawkins classification criteria, the talus fractures were classified as type Ⅱ in 4 cases and type Ⅲ in 5 cases. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 48.1±9.1. During operation, the fractures were fixed with the percutaneous cannulated screws with the assistance of the TiRobot combined with the O-arm navigation system. The operation time, hospital stay, and the occurrence of related complications were recorded. X-ray films were reviewed to evaluate the fracture healing and the occurrence of talus osteonecrosis, and the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus were measured; AOFAS ankle-hindfoot score was used to evaluated the foot function. Results The operation time ranged from 47 to 71 minutes (mean, 60.5 minutes). The length of hospital stay ranged from 2 to 5 days (mean, 3.4 days). All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17.3 months). One patient demonstrated hypoesthesia on the lateral side of foot after operation and recovered after symptomatic treatment. All fractures healed confirmed by X-ray films and the healing time ranged from 10 to 16 weeks (mean, 11.8 weeks). No talus osteonecrosis occurred during follow-up. There were significant differences in the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus between pre-operation and at last follow-up (P<0.05). At last follow-up, AOFAS ankle-hindfoot score was 91.2±5.0, the difference was significant when compared with preoperative score (t=22.169, P<0.001). The results were excellent in 16 cases and good in 9 cases, with an excellent and good rate of 100%. Conclusion TiRobot combined with O-arm navigation system for minimally invasive treatment of hindfoot fractures can obtain the satisfactory short-term effectiveness, with the advantages of less surgical trauma, precise fixation, and fewer complications.

小切口加撬拨复位治疗跟骨骨折

总结小切口加撬拨复位内固定治疗跟骨骨折的临床疗效。 方法 2005 年6 月－ 2007 年7 月收治跟骨骨折23 例25 足。男20 例，女3 例；年龄23 ～ 55 岁，平均40.5 岁。按Sanders 分型：Ⅱ型7 足，Ⅲ型17 足，Ⅳ型1 足。受伤至手术时间7 ～ 14 d，平均10 d。采用外侧横行小切口加撬拨复位，并行自体髂骨植骨（2 ～ 4 g），松质骨螺钉内固定。 结果 术后伤口均Ⅰ期愈合，无皮肤坏死和螺钉断裂发生。23 例均获随访，随访时间6 ～ 36 个月，平均15个月。术后Bouml;lher 角及Gissane 均较术前明显改善（P lt; 0.05）。患者负重行走6 个月，跟骨高度无明显丢失。根据美国足踝外科学会足部功能评分系统评定，优17 足，良6 足，可2 足，优良率92℅。 结论 小切口加撬拨复位内固定是一种治疗跟骨关节内骨折的有效方法。