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Objective: To investigate the clinical effect of the tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate compared with traditional lateral L-shaped incision approach combined with plate internal fixation in the treatment of SandersⅡ and Ⅲ calcaneal fractures., Methods: Total of 110 patients with SandersⅡ and Ⅲ calcaneal fractures admitted from March 2018 to March 2020 were selected. There were 66 males and 44 females, ranging in age from 20 to 72 years old, with an average of (48.82±8.03) years old. There were 48 SandersⅡ patients and 62 Sanders Ⅲ patients, including 41 left calcaneal fractures and 69 right calcaneal fractures. According to the surgical approach, the patients were divided into the tarsal sinus approach group and the L-shaped incision approach group, 55 cases in each group. The L-shaped incision approach group was treated with traditional lateral L-shaped incision approach combined with internal fixation plate, while the sinus tarsal approach group was treated with tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate. The operative time, intraoperative blood loss, length of hospital stay and time of fracture healing were recorded to evaluate the surgical effect. The B?hler angle, Gissane angle, calcaneal length and width of the patients before and after surgery were examined by X-ray and the surgical reduction was highly evaluated. Foot function recovery was evaluated by American Orthopedic Foot and Ankle Society (AOFAS) Maryland Scale, and postoperative complications were recorded., Results: All patients were followed up to 12 months after surgery, the operation time and hospitalization time of patients in the sinus tarsal approach group were shorter than those in the L-shaped incision approach group ( P <0.05), and the amount of intraoperative blood loss was lower than that in the L-shaped incision approach group( P <0.05). One year after surgery, B?hler angle, Gissane angle, calcaneus length and height were increased( P <0.05), calcaneus width was decreased ( P <0.05). One year after the operation, the Maryland scores of the two groups were increased( P <0.05). During the follow-up period, the incidence of postoperative complications (incision infection, joint pain, soft tissue injury) in the sinus tarsalapproach group was lower than that in the L-shaped incision approach group( P <0.05)., Conclusion: The traditional lateral L-shaped incision approach and the tarsal sinus approach are both good for the treatment of SandersⅡand Ⅲ calcaneal fractures, but the latter can shorten the surgical treatment time and reduce the incidence of complications.

Objective: To explore the clinical effect of modified interlaminar approach for the treatment of single-segment lumbar spinal stenosis., Methods: From February 2015 to August 2017, 80 patients with single-segment lumbar spinal stenosis planned to undergo endoscopic surgery were selected, including 38 males and 42 females;aged 33 to 69 (47.6±9.5) years old. Using random number table method, the patients were divided into study group and traditional group, 40 cases in each group, and underwent surgical treatment through modified translaminar approach and traditional approach respectively. The operation time, intraoperative blood loss, and hospital stay were recorded;visual analogue scale (VAS) and Oswestry Disability Index (ODI) before and after operation were compared between two groups;spinal canal arca, spinal canal diameter, disc yellow space and surgical complications were observed., Results: All 80 patients were followed up for at least 3 months. Two patients had incision infection, both of them were in traditional group;there was no significant difference in operation time between two groups( P >0.05). Intraoperative blood loss and hospital stay in study group were lower than those in traditional group( P <0.05). At 1 week and 3 months after operation, VAS and ODI of all patients were significantly lower than before operation ( P <0.05), but the difference between two groups was not statistically significant ( P >0.05). At 3 months after surgery, measured values of spinal canal area and spinal canal diameter were larger in study group than in traditional group ( P <0.05). The operative complication rate of the study group was 5.00% compared with 12.50% of the traditional group, and the difference was not statistically significant ( P >0.05)., Conclusion: Compared with the traditional approach, the modified interlaminar approach has advantages of less trauma, faster recovery and better postoperative spinal space recovery in the treatment of single-segment lumbar spinal stenosis.

Objective: To analyze the risk factors associated with mechanical ventilation before surgery in patients with acute traumatic cervical spinal cord injury(TCSCI)., Methods: According to whether preoperative mechanical ventilation, 59 patients with TCSCI admitted to our hospital from November 2016 to May 2018 were divided into mechanical ventilation(MV)group (37 cases) and non-mechanical ventilation(non-MV) group (22 cases). Falling from height was the most common causes of injury(30 cases, 50.8%), then was traffic accident(22 cases, 37.3%). The most common paraplegic plane was in C₁-C₄(36 cases, 61%). American Spinal Cord Injury Association(ASIA) injury degree and ASIA exercise score(AMS) were used to assess the extent of affected neurological plane and spinal cord injury. Trauma severity score(ISS) was used to evaluate the severity of the injury. Multivariate Logistic regression was used to analyze the risk factors for mechanical ventilation in TCSCI. ROC curves were used to assess the value of AMS and ISS in predicting mechanical ventilation., Results: Univariate analysis showed that the percentage of male, complete injury and related injuries in the MV group were significantly higher than those in the non-MV group( P <0.05). The AMS score of the MV group was significantly lower than that of the non-MV group (16.4±10.7 vs 39.1±9.5, P <0.001), and the ISS score was significantly higher than that of the non-MV group(31.6±8.0 vs 26.5±6.7, P= 0.015). Multivariate Logistic regression analysis showed that AMS[ OR= 3.340, 95% CI(1.321, 6.242), P <0.001] and ISS [ OR= 1.120, 95% CI(0.306, 3.786), P <0.001] were significant risk factors on predicting the need for mechanical ventilation.The ROC analysis showed that the area under the ROC curve(AUC) of AMS was significantly higher than that of ISS(0.899 vs 0.685, P <0.05)., Conclusions: AMS and ISS at admission can be used as predictors of early mechanically assisted ventilation., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)