Meng Qingting, Wang Qingxian, Wu Xirui, Peng Aqin, Yan Jincheng
Department of Orthopaedic Trauma, The 3rd Affiliated Hospital of Hebei Medical University, Hebei, China.
Medicine (Baltimore). 2018 Mar;97(13):e0175. doi: 10.1097/MD.0000000000010175.
To observe the clinical outcome of the sinus tarsi approach in the operative treatment of intra-articular calcaneal fractures.Forty-nine intra-articular calcaneal fractures in 45 patients were managed surgically with sinus tarsi approach. The anatomical plate and compression bolts were applied in 14 feet. The anatomical plate and screws were applied in 35 feet. Maryland foot score system was used to evaluate the function of the hindfoot at the followup.The reduction of the posterior facet was graded as nearly anatomical (less than 2 mm articular displacement) in 46 feet (93.9%). The width, height, and Böhler angle were significantly improved in all patients (P < .01). After a mean follow-up period of 18.7 months (14.5-29 months), the Maryland foot scores were: 34 feet scored 90-100 points (excellent), 6 feet scored 80-90 points (good), 6 feet scored 70-80 points (fair), and 3 feet scored 60-70 points (poor). Incision-edge necrosis occurred in 2 cases. One case suffered from incomplete medial plantar nerve injury. One case suffered from heel pad branch of the tibial nerve injury. Six cases suffered from sural nerve injury, and 4 cases sustained a lateral wound dehiscence due to a hematoma. No case suffered from lateral impingement syndrome. Up to now, no patient had to accept subtalar arthrodesis.Sinus tarsi approach provides good exposure to the subtalar joint. Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with low risk of wound-healing complications.
观察跗骨窦入路手术治疗跟骨关节内骨折的临床疗效。45例患者的49例跟骨关节内骨折采用跗骨窦入路进行手术治疗。14足应用解剖钢板和加压螺栓，35足应用解剖钢板和螺钉。采用马里兰足部评分系统在随访时评估后足功能。46足（93.9%）后关节面复位分级为接近解剖复位（关节移位小于2mm）。所有患者的跟骨宽度、高度及Böhler角均显著改善（P<0.01）。平均随访18.7个月（14.5 - 29个月）后，马里兰足部评分结果为：90 - 100分（优）34足，80 - 90分（良）6足，70 - 80分（可）6足，60 - 70分（差）3足。2例发生切口边缘坏死。1例发生足底内侧神经不完全损伤。1例发生胫神经跟垫支损伤。6例发生腓肠神经损伤，4例因血肿导致外侧伤口裂开。无1例发生外侧撞击综合征。截至目前，无患者需接受距下关节融合术。跗骨窦入路能良好显露距下关节。经跗骨窦入路切开复位内固定跟骨骨折可实现充分复位，且伤口愈合并发症风险低。
