Department of Surgery 690, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, The Netherlands.
J Bone Joint Surg Am. 2011 May 18;93(10):920-8. doi: 10.2106/JBJS.H.01834.
Surgical treatment of displaced intra-articular fractures of the calcaneus is a standard procedure in many institutions. To avoid soft-tissue complications, several minimally invasive procedures have recently been introduced. The aim of this study was to assess the percutaneous treatment of displaced intra-articular calcaneal fractures with use of one of these techniques.
All patients who underwent percutaneous screw fixation according to the method of Forgon and Zadravecz between 1998 and 2006 were selected. Postoperative infections were recorded. During follow-up, pain, functional outcome, range of motion, and change in footwear were evaluated with the use of the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Maryland Foot Score (MFS). All patients also completed a general health status form (Short Form-36 [SF-36]) and a visual analog scale (VAS) for patient satisfaction. Subsequent subtalar arthrodesis and the removal of irritating screws were performed when indicated.
We reviewed the cases of thirty-seven patients who had a combined total of thirty-nine displaced intra-articular calcaneal fractures and a follow-up period of at least twenty-four months. Five wound infections occurred, two of which were superficial and three of which were deep. At a mean follow-up time of sixty-six months, the mean AOFAS and MFS scores were 84 and 86 points, respectively, of 100 possible points. The mean score on the SF-36 was 76 points, and the mean score on the visual analog scale for patient satisfaction was 7.9 points of 10 possible points. Twenty-nine patients (78%) were able to wear normal shoes. At the time of follow-up, subtalar arthrodesis had been performed in two patients and seventeen patients (46%) had undergone an uncomplicated removal of painful screws. No substantial correlation was found between the severity of the fracture (Sanders classification) or the quality of the reduction when correlated with functional outcome parameters.
We consider the technique of Forgon and Zadravecz to be an excellent option for the treatment of displaced intra-articular calcaneal fractures in selected patients despite the frequent need for screw removal following fracture-healing.
在许多医疗机构中，手术治疗移位的关节内跟骨骨折是一种标准程序。为了避免软组织并发症，最近引入了几种微创技术。本研究的目的是评估使用其中一种技术经皮治疗移位的关节内跟骨骨折。
选择 1998 年至 2006 年间接受福冈和扎德拉维茨（Forgon and Zadravecz）方法经皮螺钉固定的所有患者。记录术后感染情况。在随访期间，使用美国矫形足踝协会（AOFAS）评分和马里兰足部评分（MFS）评估疼痛、功能结果、活动范围以及换鞋情况的变化。所有患者还填写了一般健康状况表（简短形式 36 [SF-36]）和患者满意度视觉模拟评分（VAS）。当需要时，进行后续的距下关节融合术和去除刺激性螺钉。
我们回顾了 37 例患者的病例，这些患者共有 39 例合并的关节内跟骨骨折，随访时间至少 24 个月。发生了 5 例伤口感染，其中 2 例为浅表感染，3 例为深部感染。在平均 66 个月的随访时，AOFAS 和 MFS 的平均得分为 84 分和 86 分（满分 100 分）。SF-36 的平均得分为 76 分，患者满意度视觉模拟评分的平均得分为 7.9 分（满分 10 分）。29 例患者（78%）能够穿正常的鞋子。随访时，2 例患者行距下关节融合术，17 例患者（46%）行无痛螺钉取出术，均未出现并发症。在功能结果参数方面，骨折严重程度（桑德斯分类）或复位质量与无相关性。
尽管骨折愈合后经常需要取出螺钉，但我们认为福冈和扎德拉维茨的技术对于选择的患者治疗移位的关节内跟骨骨折是一种极好的选择。
