Islam Amirul, Mcdonald Charles, Aljawadi Ahmed, Niazi Noman, Pillai Anand
Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR.
Surgery, University of Manchester, Manchester, GBR.
Cureus. 2020 Aug 4;12(8):e9547. doi: 10.7759/cureus.9547.
Objectives The ideal treatment of displaced intra-articular calcaneal fractures continues to be a subject of debate. The aim of the study was to compare the radiological outcome, cumulative radiation exposure, surgical time, time to surgery, wound healing times and cost involved in minimally invasive surgery (MIS) and open reduction internal fixation (ORIF) for calcaneal fractures. Methods This was a retrospective study of 39 calcaneum operated in our unit during 2012 to 2019, of which 20 had undergone ORIF and 19 had been operated upon following MIS. Results A total of 39 calcanea (37 patients) were operated, of which 20 had open procedure and 19 had MIS procedure, including one bilateral surgery in each group. Mean age of the patients in the MIS group was 42.18 years (range: 15-68 years) and that of the patients in the open group was 43 years (range: 21-75 years). Of the fractures, 53.84% (n = 21) was Sanders type III, 28.20% (n = 11) was type II and 17.94% (n = 7) was type IV. There was no statistically significant difference in the mean correction of Bohler's angle and Gissane's angle between the groups. The mean cost for implant used for each open procedure was £882.79, and the implant cost for each MIS procedure was £142.89. Mean utilisation of cumulative X-ray dose was significantly higher in MIS (0.764 mGy) in comparison to open surgery (0.392 mGy). The average surgical time for MIS was 64.9 minutes and that of open surgery was 106.3 minutes. Average waiting time for MIS was 6.6 days and that for ORIF was 9.8 days. Wound healing was quicker (average 13.4 days) in MIS than ORIF (average 17.2 days). All these differences were statistically significant. Conclusions Minimally invasive calcaneal fracture surgery is quicker and cheaper and can be performed earlier. It is associated with early wound healing, although it requires higher cumulative radiation dose.
目的 对于移位的关节内跟骨骨折，理想的治疗方法仍是一个有争议的话题。本研究的目的是比较微创（MIS）手术和切开复位内固定（ORIF）治疗跟骨骨折的放射学结果、累积辐射暴露量、手术时间、手术时机、伤口愈合时间和成本。方法 这是一项对2012年至2019年在本单位接受手术的39例跟骨病例的回顾性研究，其中20例行ORIF手术，19例行MIS手术。结果 共对39例跟骨（37例患者）进行了手术，其中20例采用切开手术，19例采用MIS手术，每组各有1例双侧手术。MIS组患者的平均年龄为42.18岁（范围：15 - 68岁），切开组患者的平均年龄为43岁（范围：21 - 75岁）。在骨折中，53.84%（n = 21）为Sanders III型，28.20%（n = 11）为II型，17.94%（n = 7）为IV型。两组之间Bohler角和Gissane角的平均矫正度无统计学显著差异。每次切开手术所用植入物的平均成本为882.79英镑，每次MIS手术的植入物成本为142.89英镑。与切开手术（0.392 mGy）相比，MIS组累积X射线剂量的平均使用量显著更高（0.764 mGy）。MIS的平均手术时间为64.9分钟，切开手术的平均手术时间为106.3分钟。MIS的平均等待时间为6.6天，ORIF的平均等待时间为9.8天。MIS的伤口愈合更快（平均13.4天），而ORIF的伤口愈合平均为17.2天。所有这些差异均具有统计学显著性。结论 微创跟骨骨折手术更快、更便宜，且可更早进行。它与伤口早期愈合相关，尽管需要更高的累积辐射剂量。
