Lim Philip K, Miller Adam J, Haghverdian Justin, Meremikwu Ramzy, Shaath M Kareem, Munz John W
UC Irvine Medical Center, Irvine, California.
University of Texas, Houston, Houston, Texas.
Foot Ankle Spec. 2023 Apr 3;18(4):19386400231152096. doi: 10.1177/19386400231152096.
The aim of the study is to investigate the differences between the extensile lateral (EL) and sinus tarsi (ST) approaches for the treatment of displaced intra-articular calcaneus fractures as treated by a single surgeon.
A retrospective cohort study performed at a Level 1 trauma center. One hundred twenty-nine consecutive intra-articular calcaneus fractures from 2011 to 2018 that were surgically treated by a single surgeon. Primary outcomes were time to surgery, operative time, postoperative restoration of the critical angle of Gissane, postoperative wound complications, and need for unplanned re-operation.
Patient characteristics, including demographics, mechanism of injury, and fracture patterns were similar between the EL and ST approach groups. There was a significant decrease in unplanned secondary procedures (P = .008), shorter time to definitive fixation (P = .00001), and shorter average operative time in the ST group (P = .00001). Postoperative measurement of the critical angle of Gissane between the two groups was significantly different, but minute with an average difference of approximately 3 degrees (P = .025). Measurements in both groups were within the expected range of normal.
For displaced intra-articular calcaneus fractures, a limited open ST approach is associated with a significant reduction in the time to definitive fixation and decreased operative time. The EL approach was associated with a small, but significant improvement in the restoration of the critical angle of Gissane compared with the ST approach. Therefore, an ST approach may allow for earlier surgical intervention and result in equivalent quality of reduction compared with an EL approach.
Level III.
本研究旨在调查由同一位外科医生采用的外侧延长（EL）入路和距下窦（ST）入路治疗移位的关节内跟骨骨折的差异。
在一级创伤中心进行一项回顾性队列研究。纳入2011年至2018年由同一位外科医生手术治疗的129例连续关节内跟骨骨折患者。主要结局指标包括手术时间、手术时长、术后Gissane角的恢复情况、术后伤口并发症以及计划外再次手术的需求。
EL入路组和ST入路组患者的特征，包括人口统计学资料、损伤机制和骨折类型相似。ST组计划外二次手术显著减少（P = 0.008），确定性固定时间更短（P = 0.00001），平均手术时间更短（P = 0.00001）。两组术后Gissane角的测量结果有显著差异，但差异微小，平均差异约为3度（P = 0.025）。两组测量结果均在正常预期范围内。
对于移位的关节内跟骨骨折，有限切开ST入路与确定性固定时间显著缩短和手术时间减少相关。与ST入路相比，EL入路在Gissane角恢复方面有小但显著的改善。因此，与EL入路相比，ST入路可能允许更早的手术干预且复位质量相当。
三级。
