Yuan Cheng-song, Tan Xiao-kang, Zhou Bing-Hua, Liu Jun-peng, Tao Xu, Tang Kang-Lai
Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
J Orthop Surg Res. 2014 Nov 19;9:115. doi: 10.1186/s13018-014-0115-2.
There are many existing operative approaches for subtalar fusion; however, no optional strategy of operative approach has been developed yet. This study aimed to analyze the differential clinical efficacy of subtalar fusion with three operative approaches.
The clinical data of 102 patients from April 2008 to April 2012 were analyzed prospectively. These patients were divided into three groups with the random number table: group A, group B, and group C. The following parameters were compared among three groups: effective exposure area and exposure time of subtalar joint, intraoperative bleeding volume, postoperative complications, fusion time, fusion rate, AOFAS score and VAS score before and after operation.
In the exposure area score, there was no statistically significant difference between group A and group C (P > 0.05) ,but with a statistically significant difference between group A/C and group B (P < 0.05). In exposure time and intraoperative bleeding volume, there was no statistically significant difference between group A and group B (P > 0.05) but with a statistically significant difference between group A/B and group C (P < 0.05). In three groups, there was a statistically significant difference in both AOFAS score and VAS score before operation and at 6 months/12 months/last visit after operation (P < 0.05). The incidence of complications in the three groups was 8.8%, 12.5% and 19.4%. No statistically significant differences in fusion rate and fusion time were observed among the three groups (P > 0.05).
Three operative approaches have different indications, All the three operative approaches do not influence the fusion rate and fusion time of subtalar joint. The lateral tarsal sinus approach is inferior to the posterior-lateral L approach and the approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone in the exposure area, while the lateral tarsal sinus approach and the approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone are superior to the posterior-lateral L approach in the exposure time, intraoperative bleeding volume, and incidence of complications.
距下关节融合术现有多种手术入路；然而，尚未形成手术入路的最佳策略。本研究旨在分析三种手术入路行距下关节融合术的临床疗效差异。
前瞻性分析2008年4月至2012年4月102例患者的临床资料。采用随机数字表法将患者分为A组、B组和C组。比较三组的以下参数：距下关节有效暴露面积及暴露时间、术中出血量、术后并发症、融合时间、融合率、术前及术后6个月/12个月/末次随访时的美国足踝外科协会（AOFAS）评分及视觉模拟评分（VAS）。
暴露面积评分方面，A组与C组差异无统计学意义（P>0.05），但A/C组与B组差异有统计学意义（P<0.05）。暴露时间及术中出血量方面，A组与B组差异无统计学意义（P>0.05），但A/B组与C组差异有统计学意义（P<0.05）。三组术前及术后6个月/12个月/末次随访时的AOFAS评分及VAS评分差异均有统计学意义（P<0.05）。三组并发症发生率分别为8.8%、12.5%和19.4%。三组融合率及融合时间差异无统计学意义（P>0.05）。
三种手术入路适应证不同，三种手术入路均不影响距下关节的融合率及融合时间。跗骨窦外侧入路在暴露面积方面劣于后外侧L形入路及腓骨尖至第4跖骨基底入路，而跗骨窦外侧入路及腓骨尖至第4跖骨基底入路在暴露时间、术中出血量及并发症发生率方面优于后外侧L形入路。
