Department of Orthopaedic Surgery, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
J Trauma Acute Care Surg. 2012 Sep;73(3):743-51. doi: 10.1097/TA.0b013e318253b5f1.
The purpose of this study is to assess the clinical results of a minimally invasive treatment featured the concept of internal compression, including an anatomic plate and multiple compression bolts compared with open reduction and internal fixation for displaced intra-articular calcaneal fractures (DIACFs).
We retrospectively analyzed 329 patients (383 feet) who were identified from trauma inpatient database in our hospital for DIACFs from January 2004 to December 2009. Of them, 148 patients (170 feet) were treated with open reduction and internal fixation (OR group), which involved using a traditional L-shaped extended lateral approach, and fractures were fixed by plate and screws from January 2004 to December 2006; 181 patients (213 feet) were treated with a minimally invasive approach featured the concept of calcaneal internal compression (CIC group), which was achieved by an anatomic plate and multiple compression bolts through a small lateral incision from January 2007 to December 2009. Postoperative complications were recorded. During follow-up, pain and functional outcome were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) scores and compared between the two groups. Subsequent subtalar arthrodesis and early implant removal were performed when indicated. Routine hardware removal was scheduled for all patients at 1-year follow-up.
There were no significant differences in sex, age, and fracture classification (Sanders classification) between the two groups. Wound healing complications were 4 of 213 (1.88%) in CIC group and 20 of 170 (11.76%) in OR group. Subtalar arthrodesis had to be performed in one case in OR group. Four cases in CIC group and four cases in OR group had the hardware removed earlier due to complications. The average time after surgery to start weight-bearing exercise is 5.64 weeks in CIC group and 9.38 weeks in OR group (p < 0.001). The mean AOFAS score is higher in CIC group than in OR group, although the difference is not statistically significant (87.53 vs. 84.95; p = 0.191). The overall results according to the AOFAS scoring system were good or excellent in 185 of 213 (86.85%) in CIC group and 144 of 170 (84.71%) in OR group. The subjective portion of the AOFAS survey answered by patients showed statistically significant difference in activity limitation and walking surface score (7.31 vs. 7.02 and 3.72 vs. 3.42; p < 0.05) but not in pain and walking distance between the two groups (32.72 vs. 32.29 and 4.37 vs. 4.42; p > 0.05).
The study results suggest that this minimally invasive approach featured the concept of the calcaneal internal compression can achieve functional outcome as good as, if not better than the open techniques. It is proved to be an effective alternative treatment for DIACFs.
Therapeutic study, level IV.
本研究旨在评估微创治疗概念下的内压缩，包括解剖板和多个压缩螺栓与切开复位内固定治疗关节内移位跟骨骨折（DIACFs）的临床效果。
我们回顾性分析了 2004 年 1 月至 2009 年 12 月我院创伤住院数据库中 329 例（383 足）DIACFs 患者。其中 148 例（170 足）采用切开复位内固定（OR 组）治疗，采用传统 L 形延长外侧入路，采用钢板和螺钉固定，治疗时间为 2004 年 1 月至 2006 年 12 月；181 例（213 足）采用微创内压缩（CIC）方法治疗，采用解剖板和多个压缩螺栓通过小的外侧切口，治疗时间为 2007 年 1 月至 2009 年 12 月。记录术后并发症。随访时采用美国矫形足踝协会（AOFAS）评分评估疼痛和功能结果，并比较两组。随后在需要时进行距下关节融合和早期植入物取出。所有患者均在 1 年随访时常规取出内固定。
两组患者在性别、年龄和骨折分类（Sanders 分类）方面无显著差异。CIC 组的伤口愈合并发症为 4 例（1.88%），OR 组为 20 例（11.76%）。OR 组中有 1 例需要行距下关节融合术。CIC 组有 4 例和 OR 组有 4 例因并发症而提前取出内固定。CIC 组术后开始负重活动的平均时间为 5.64 周，OR 组为 9.38 周（p<0.001）。尽管差异无统计学意义（CIC 组 87.53 分，OR 组 84.95 分；p=0.191），但 CIC 组的 AOFAS 评分高于 OR 组。根据 AOFAS 评分系统，CIC 组 185 例（86.85%）和 OR 组 144 例（84.71%）的总体结果良好或优秀。患者主观 AOFAS 调查的活动受限和步行表面评分存在统计学差异（7.31 分比 7.02 分和 3.72 分比 3.42 分；p<0.05），但两组的疼痛和步行距离无统计学差异（32.72 分比 32.29 分和 4.37 分比 4.42 分；p>0.05）。
研究结果表明，微创治疗概念下的这种内压缩方法可以达到与切开复位内固定术相当甚至更好的功能结果，被证明是 DIACFs 的有效替代治疗方法。
治疗性研究，IV 级。
