Summary

To analyze the differential clinical efficacy of subtalar fusion with three operative approaches and explore the clinical selection strategy of single operative approach for subtalar fusion.

Abstract

[Abstract] Objective: To analyze the differential clinical efficacy of subtalar fusion with three operative approaches and explore the clinical selection strategy of single operative approach for subtalar fusion. Methods: The clinical data of 102 patients with severe subtalar arthritis who were admitted to our department from April 2008 to April 2012 were analyzed prospectively. These patients were divided into three groups with the random number table: group A (subtalar fusion in situ with an approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone, n=34), group B (subtalar fusion in situ with a lateral tarsal sinus approach, n=32), and group C (subtalar fusion in situ with a posterior-lateral L approach, n=36). The following parameters were compared among three groups: effective exposure area and exposure time of subtalar joint, perioperative bleeding volume, postoperative complications, fusion time, fusion rate, AOFAS score and VAS score before and after operation. Results: In exposure area score, there was no statistically significant difference between group A and group C (P>0.05), but a statistically significant difference between group A/C and group B (P<0.05). In exposure time and perioperative bleeding volume, there was no statistically significant difference between group A and group B (P>0.05), but a statistically significant difference between group A/B and group C (P<0.05). In three groups, there was a statistically significant difference in both AOFAS score and VAS score between before operation and at 6m/12m/last visit after operation (P<0.05); at 6m, 12m and last visit after operation, there were no statistically significant differences in both AOFAS score and VAS score among three groups (P>0.05). The incidence of complications in three groups was 8.8%, 12.5% and 19.4%, respectively, and the incidence of complications in group C was evidently greater than those in group A and group B. No statistically significant differences in fusion rate and fusion time were observed among three groups (P>0.05). Conclusion: Three operative approaches have different indications, thus an applicable approach shall be selected according to the disease characteristics and the operative purpose. All the three operative approaches do not influence the fusion rate and fusion time of subtalar joint. The approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone and the lateral tarsal sinus approach are inferior to the posterior-lateral L approach in the aspect of exposure area, but superior in exposure time, perioperative bleeding volume, and incidence of complications. And the former two approaches also have a higher requirement for surgeons.
Keywords: Subtalar joint; Arthritis; Joint fusion, arthrodesis; Operative approach; Controlled clinical trial