ObjectiveTo investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures.MethodsBetween January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative Böhler angle, Gissane angle, visual analogue scale (VAS) core (P>0.05), which were comparable. The operation time, postoperative drainage volume, postoperative Böhler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness.ResultsAll the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups (P>0.05). Patients in both groups were followed up 12-36 months (mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups (t=0.30, P=0.77). The postoperative Böhler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation (P<0.05); however, there was no significant difference in Böhler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation (P>0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups (P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation (P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation (t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group (t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups (χ2=1.98, P=0.16).ConclusionThe modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.
ObjectiveTo analyze the current status and risk factors of postoperative complications in patients with retroperitoneal tumor (RPT) and to establish a nomogram for predicting the occurrence of postoperative complications. MethodsThe clinicopathologic data of patients with RPT who met the inclusion criteria in the West China Hospital of Sichuan University from June 2019 to May 2022 were retrospectively collected. The risk factors of postoperative complications were analyzed by using univariate and multivariate analyses, and the nomogram was constructed based on the risk factors and validated. ResultsA total of 205 patients were collected in this study, 70 (34.1%) of whom had postoperative complications. The multivariate analysis results of logistic regression showed that the preoperative serum albumin ＜35 g/L [OR=2.355, 95%CI (1.256, 4.416), P=0.008], tumor sarcoma [OR=2.498, 95%CI (1.219, 5.120), P=0.012], and visceral resection [OR=2.008, 95%CI (1.042, 3.868), P=0.037] increased the probability of postoperative complications for the patients with RPT. The area under the receiver operating characteristic curve of the nomogram based on the risk factors in predicting the occurrence of postoperative complications was 0.704 [95%CI (0.626, 0.781), P<0.001]. The consistency index of the nomogram by internal verification was 0.704 [95%CI (0.628, 0.779)]. The calibration curve of the nomogram showed that the predicted value was basically consistent with the actual value, the Hosmer-Lemeshow goodness-of-fit test model had a good goodness-of-fit (χ2=3.407, P=0.906). ConclusionsFrom the results of this study, the tumor sarcoma, lower preoperative serum albumin, and visceral resection are associated with postoperative complications for patients with RPT. The nomogram based on risk factors has a good predictive value for postoperative complications.