Sanders II型和III型跟骨骨折内固定的外侧扩展入路与距下窦入路比较：186例骨折的随机对照试验
Extensible lateral approach versus sinus tarsi approach for sanders type II and III calcaneal fractures osteosynthesis: a randomized controlled trial of 186 fractures.
作者信息
Fadle Amr A, Khalifa Ahmed A, Shehata Peter Mamdouh, El-Adly Wael, Osman Ahmed Ekram
机构信息
Orthopaedic Department, Assiut Faculty of Medicine, Assiut University Hospital, Assiut University, Kasr Elini Street, Number 7, P.O. Box 110, Assuit, 71515, Egypt.
Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
出版信息
J Orthop Surg Res. 2025 Jan 3;20(1):8. doi: 10.1186/s13018-024-05345-z.
AIMS
Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT's primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes.
METHODS
Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler's and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score.
RESULTS
No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p = 0.001). STA's operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p < 0.05), and no statistical difference regarding intraoperative radiation exposure. The time to fracture union was significantly shorter in STA (6.33 ± 0.8 vs. 7.13 ± 0.7 weeks, p = 0.000). Skin complications (superficial or deep infection) and Subtalar osteoarthritis were significantly higher in ELA (18.9% vs. 3.3%, p = 0.001) and (32.6% vs. 9.9%, p = 0.001), respectively. The radiological parameters were significantly better in STA postoperatively and at the last follow up. The AOFAS scores were significantly better in STA (83.49 ± 7.71 vs. 68.62 ± 7.05, respectively, p = 0.000).
CONCLUSION
During osteosynthesis of Sanders type II and III DIACFs, STA is superior to ELA in terms of operating earlier, shorter operative time, fewer complications, and better radiological and functional outcomes.
目的
对于关节内移位型跟骨骨折（DIACF）的接骨术，哪种外侧延长入路（ELA）或距下窦入路（STA）是最佳选择仍存在争议。当前随机对照试验的主要目的是比较通过STA与ELA对DIACF进行切开复位内固定术后的并发症发生率。次要目的是术中辐射暴露、骨折愈合时间、功能和影像学结果的差异。
方法
在2020年8月至2023年2月期间，157例Sanders II型和III型骨折患者被随机分为ELA组（81例患者，95处骨折）或STA组（76例患者，91处骨折）。主要结局是并发症的发生率。次要结局是Böhler角和Gissane角、骨折愈合情况以及美国矫形足踝协会（AOFAS）评分。
结果
两组在基本人口统计学数据、损伤特征和骨折分类方面无统计学差异；然而，STA组患者的手术时间明显更早（4.43±7.37天 vs. 7±6.42天，p = 0.001）。STA组的手术时间明显更短（55.83±7.35分钟 vs. 89.66±7.12分钟，p < 0.05），术中辐射暴露无统计学差异。STA组的骨折愈合时间明显更短（6.33±0.8周 vs. 7.13±0.7周，p = 0.000）。ELA组的皮肤并发症（浅表或深部感染）和距下骨关节炎明显更高（分别为18.9% vs. 3.3%，p = 0.001）和（32.6% vs. 9.9%，p = 0.001）。术后及末次随访时，STA组的影像学参数明显更好。STA组的AOFAS评分明显更好（分别为83.49±7.71 vs. 68.62±7.05，p = 0.000）。
结论
在Sanders II型和III型DIACF的接骨术中，STA在手术时间更早、手术时间更短、并发症更少以及影像学和功能结果更好方面优于ELA。
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