Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
J Orthop Trauma. 2010 Aug;24(8):466-72. doi: 10.1097/BOT.0b013e3181defd74.
The purpose of this study is to assess the initial results of percutaneously reducing and fixing calcaneus fractures compared with a concurrent control group that was openly reduced and internally fixed through an extensile lateral approach.
Retrospective cohort study, consecutive series.
Level I trauma center.
PATIENTS/PARTICIPANTS: One hundred twenty patients with 125 intra-articular calcaneus fractures were selected as a consecutive series with treatment method randomized by surgeon and time of presentation.
Patients treated with open reduction and internal fixation (OR group) had an extended lateral approach and fractures were fixed with plates and screws. Patients treated with percutaneous reduction (PR group) had small incisions with indirect fragment manipulation, and the reduction achieved was secured with screws alone.
Clinical and radiographic assessment.
There were 41 patients with 42 fractures in the OR group and 79 patients with 83 fractures in the PR group. There were no significant differences in sex, age, open fractures, fracture classification, or initial Bohler's angle between the two groups. Bohler's angle was improved after surgery by an average of 22.4 degrees in the OR group and 25.3 degrees in the PR group (P = 0.31). The average loss of reduction at healing (minimum 4 months postoperatively) was not significantly different between the two groups. Deep infection occurred in six of 42 of the OR group and zero of 83 of the PR group (P = 0.002). The incidence of minor wound complications was nine of 42 in the OR group and five of 83 in the PR group (P = 0.03). The need for late subtalar fusions (two of 26 and three of 41 with full 2-year follow-up) and implant removal (five of 42 and 10 of 83) was not significantly different.
The results of this study suggest that in comparison to open reduction, this method of percutaneously reducing and fixing calcaneus fractures minimizes complications and achieves and maintains extra-articular reductions as well as the standard extensile open reduction and internal fixation. Further study of this technique is warranted. This should include assessment of articular reduction and longer follow-up of a larger number of patients.
本研究旨在评估经皮复位固定与同期外侧扩大入路切开复位内固定治疗跟骨关节内骨折的初步结果。
回顾性队列研究，连续系列。
一级创伤中心。
患者/参与者：选择 120 例 125 例关节内跟骨骨折患者作为连续系列，根据外科医生和就诊时间随机选择治疗方法。
切开复位内固定（OR 组）采用外侧延长入路，用钢板和螺钉固定骨折；经皮复位（PR 组）采用小切口间接复位，用螺钉固定复位。
临床和影像学评估。
OR 组 41 例 42 例骨折，PR 组 79 例 83 例骨折。两组患者性别、年龄、开放性骨折、骨折分类、初始 Bohler 角无统计学差异。OR 组术后平均改善 Bohler 角 22.4 度，PR 组 25.3 度（P = 0.31）。两组愈合时复位丢失程度无显著差异。OR 组 42 例中有 6 例发生深部感染，PR 组 83 例中无感染（P = 0.002）。OR 组 42 例中有 9 例出现轻微伤口并发症，PR 组 83 例中有 5 例（P = 0.03）。需要后期行跟距融合（26 例中有 2 例，41 例中有 3 例随访 2 年以上）和取出内固定（42 例中有 5 例，83 例中有 10 例）的比例无显著差异。
与切开复位相比，该方法经皮复位固定跟骨关节内骨折可降低并发症发生率，维持关节外复位，达到标准外侧切开复位内固定效果。需要进一步研究该技术，包括评估关节复位和对更多患者进行更长时间的随访。
