Jin Cong, Weng Dong, Yang Wanlei, He Wei, Liang Wengqing, Qian Yu
Department of Orthopaedics, Shaoxing People's Hospital, Zhongxing North Road, Shaoxing, Zhejiang, 312000, People's Republic of China.
J Orthop Surg Res. 2017 Jan 18;12(1):10. doi: 10.1186/s13018-017-0511-5.
This randomized controlled trial compared the clinical outcomes and complications of a novel minimally invasive percutaneous osteosynthesis (MIPO) with those of conventional treatment via an extended L-shaped lateral approach for calcaneal fractures.
Sixty-four patients with displaced intraarticular calcaneal fractures were enrolled. The patients were randomly allocated to receive either MIPO (29 patients) or open reduction and internal fixation via an extended L-shaped lateral approach (35 patients). The same calcaneal plate (AO Synthes, Oberdorf, Switzerland) was used in both groups. The primary clinical outcomes included operative time, VAS postoperatively, and wound healing complications. Secondary clinical outcomes included time to operation, length of incision, postoperative drainage, length of hospital stay, medical expense, AOFAS score, and SF-36 score. Preoperative and postoperative calcaneal height, width, and length, Bohler's angle, and Gissane's angle were compared.
The operative time in the MIPO group was 52.5 ± 11.1 min, which was significantly shorter than 82.8 ± 16.2 min in the conventional treatment group (P < 0.001). One week postoperatively, the VAS value was 3.2 ± 1.4 in the MIPO group, which was lower than that in the conventional treatment group, 3.9 ± 1.3 (P = 0.038). In the conventional treatment group, 13 of 35 fractures (37.1%) had wound healing problems, whereas this issue occurred in only 2 of 29 fractures (6.7%) in the MIPO group (P = 0.004). In the MIPO group, deep and superficial infections occurred in none of the cases and 1 of 29 (3.4%) patients, respectively. Length of incision in the MIPO group was shorter than that in the conventional treatment group (4.2 ± 0.6 vs. 10.9 ± 1.5 cm; P < 0.001). Hospital stay was 9.7 ± 2.8 days in the MIPO group and 11.7 ± 2.6 days in the conventional treatment group (P = 0.004). At the last follow-up, the SF-36 scores and AOFAS scores in the two groups were comparable (P > 0.05). The postoperative radiographic data, the Bohler's angle, Gissane's angle, and calcaneal height, width, and length in the two groups were comparable (P > 0.05).
Compared with conventional ORIF, the advantages of MIPO are a considerably shortened operating time and hospital stay, decreased postoperative pain, and reduced risk of wound healing complications.
本随机对照试验比较了新型微创经皮接骨术（MIPO）与传统的经延长L形外侧入路治疗跟骨骨折的临床疗效及并发症。
纳入64例移位的关节内跟骨骨折患者。患者被随机分配接受MIPO治疗（29例）或经延长L形外侧入路切开复位内固定治疗（35例）。两组均使用相同的跟骨钢板（AO Synthes，瑞士奥伯多夫）。主要临床疗效指标包括手术时间、术后视觉模拟评分（VAS）和伤口愈合并发症。次要临床疗效指标包括手术等待时间、切口长度、术后引流量、住院时间、医疗费用、美国足踝外科协会（AOFAS）评分和简明健康状况调查量表（SF-36）评分。比较术前和术后跟骨的高度、宽度、长度、Bohler角和Gissane角。
MIPO组的手术时间为52.5±11.1分钟，明显短于传统治疗组的82.8±16.2分钟（P<0.001）。术后1周，MIPO组的VAS值为3.2±1.4，低于传统治疗组的3.9±1.3（P=0.038）。传统治疗组35例骨折中有13例（37.1%）出现伤口愈合问题，而MIPO组29例骨折中仅2例（6.7%）出现此问题（P=0.004）。MIPO组无一例发生深部感染，29例中有1例（3.4%）发生浅表感染。MIPO组的切口长度短于传统治疗组（4.2±0.6 vs. 10.9±1.5 cm；P<0.001）。MIPO组的住院时间为9.7±2.8天，传统治疗组为11.7±2.6天（P=0.004）。在最后一次随访时，两组的SF-36评分和AOFAS评分相当（P>0.05）。两组术后的影像学数据，包括Bohler角、Gissane角以及跟骨的高度、宽度和长度相当（P>0.05）。
与传统切开复位内固定术相比，MIPO的优势在于手术时间和住院时间显著缩短、术后疼痛减轻以及伤口愈合并发症风险降低。
