Chen Zhanfa, Zhang Yingze, Zheng Zhanle, Guo Mingke
Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang Hebei 050051, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Aug;23(8):925-9.
To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures.
From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwent minimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type II, 11 of type III, and 2 of type IV according to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type II, 11 of type III and 23 of type IV according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P > 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed.
All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P < 0.05), whereas in the experimental group, no significant differences were noted between the injured foot and the normal foot in terms of the above parameters (P > 0.05). Significant differences were noted between two groups in terms of the above parameters (P < 0.05). The Maryland score 1 year after operation was (86.74 +/- 8.56) points for the experimental group and (71.24 +/- 10.06) points for the control group; at 2 years after operation, it was increased to (87.35 +/- 8.49) points and (72.41 +/- 9.69) points, respectively, indicating there was a significant difference between two groups (P < 0.05).
Operative outcomes of internal fixation with improved compressing plate are superior to those of standard AO plate. Footscan system can provide a quantitative assessment on the operative effect of calcaneus fractures.
探讨运用Footscan系统评估两种内固定方法治疗跟骨骨折疗效的价值。
2006年2月至2006年9月，将64例新鲜单侧闭合性跟骨骨折患者随机分为两组。实验组：32例患者采用改良加压钢板螺钉微创切开复位内固定术，其中男性28例，女性4例，年龄20 - 53岁（平均36.7岁）；病程3 - 14天；根据Sanders骨折分类系统，Ⅱ型19例，Ⅲ型11例，Ⅳ型2例。对照组：32例患者采用L形切口标准AO钢板内固定术，其中男性29例，女性3例，年龄18 - 56岁（平均37.1岁）；病程4 - 15天；根据Sanders骨折分类系统，Ⅱ型18例，Ⅲ型11例，Ⅳ型3例。两组一般资料比较差异无统计学意义（P > 0.05）。术后1年和2年，采用Footscan系统测量动态足底压力，比较两组Maryland足评分，并进行统计学分析。
所有患者均随访2年。实验组未发生感染、切口边缘坏死及腓肠神经远端损伤，而对照组有3例患者发生切口边缘坏死，经换药后愈合，1例患者出现腓肠神经远端损伤，局部皮肤感觉减退。术后1年和2年，对照组双足站立时患足与正常足相比，在冲量、足背指数、距下关节活动范围、足底压力中心横向位移及跟骨宽度方面差异有统计学意义（P < 0.05），而实验组上述参数患足与正常足相比差异无统计学意义（P > 0.05）。两组上述参数比较差异有统计学意义（P < 0.05）。实验组术后1年Maryland评分为（86.74 ± 8.56）分，对照组为（71.24 ± 10.06）分；术后2年，分别提高至（87.35 ± 8.49）分和（72.41 ± 9.69）分，两组比较差异有统计学意义（P < 0.05）。
改良加压钢板内固定术的手术效果优于标准AO钢板。Footscan系统可对跟骨骨折手术效果进行定量评估。
