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Abstract：
BACKGROUND: The extensile lateral approach (ELA) and sinus tarsi approach (STA) are commonly utilized for surgically treating calcaneal fractures. This study compared the outcomes of ELA and STA in the management of calcaneal fractures and assessed the influence of postoperative quality of reduction on functional and pain scores.
METHODS: The study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits.
RESULTS: Out of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized β coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized β coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized β coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores.
CONCLUSIONS: In conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.
METHODS: The study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits.
RESULTS: Out of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized β coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized β coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized β coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores.
CONCLUSIONS: In conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.
摘要：
背景：可伸展性外侧入路（ELA）和骨窦入路（STA）通常用于手术治疗跟骨骨折。这项研究比较了ELA和STA治疗跟骨骨折的结果，并评估了术后复位质量对功能和疼痛评分的影响。
方法：该研究纳入了68例接受ELA或STA手术的SandersII型和III型跟骨骨折的成年人。分析术前和术后的X光片和计算机断层扫描，使用曼彻斯特牛津足部问卷（MOXFQ）评估功能和疼痛评分，美国骨科足踝协会（AOFAS）踝足-后足评分，随访期间的视觉模拟评分(VAS)。
结果：在所有患者中，50例接受了ELA手术，18例接受了STA手术。33例（48.5％）患者的解剖（出色）减少。ELA组和STA组的功能评分无显著差异，疼痛评分,优秀还原的比例，和并发症。此外,解剖还原,与近解剖或非解剖相比(好，公平,或不良)减少，显示MOXFQ下降(未标准化β系数：-13.83，95%CI：-25.47至-2.19，p=0.021)，AOFAS增加(非标准化β系数：8.35，95%CI：0.31至16.38，p=0.042)，VAS疼痛评分降低（非标准化β系数：-0.89，95%CI：-1.93至-0.16，p=0.095）。
结论：结论：我们发现并发症没有显着差异，优秀的还原，STA和ELA手术之间的功能评分。因此,STA可能是治疗SandersII型和III型跟骨骨折的有效替代方法。此外，后小关节的解剖减少与改善的功能评分相关，强调实现它对于恢复足部功能的重要性，无论手术类型或受伤和手术之间的时间。
方法：该研究纳入了68例接受ELA或STA手术的SandersII型和III型跟骨骨折的成年人。分析术前和术后的X光片和计算机断层扫描，使用曼彻斯特牛津足部问卷（MOXFQ）评估功能和疼痛评分，美国骨科足踝协会（AOFAS）踝足-后足评分，随访期间的视觉模拟评分(VAS)。
结果：在所有患者中，50例接受了ELA手术，18例接受了STA手术。33例（48.5％）患者的解剖（出色）减少。ELA组和STA组的功能评分无显著差异，疼痛评分,优秀还原的比例，和并发症。此外,解剖还原,与近解剖或非解剖相比(好，公平,或不良)减少，显示MOXFQ下降(未标准化β系数：-13.83，95%CI：-25.47至-2.19，p=0.021)，AOFAS增加(非标准化β系数：8.35，95%CI：0.31至16.38，p=0.042)，VAS疼痛评分降低（非标准化β系数：-0.89，95%CI：-1.93至-0.16，p=0.095）。
结论：结论：我们发现并发症没有显着差异，优秀的还原，STA和ELA手术之间的功能评分。因此,STA可能是治疗SandersII型和III型跟骨骨折的有效替代方法。此外，后小关节的解剖减少与改善的功能评分相关，强调实现它对于恢复足部功能的重要性，无论手术类型或受伤和手术之间的时间。
