Buckley Richard, Leighton Ross, Sanders David, Poon Jeffrey, Coles Chad P, Stephen David, Paolucci Elizabeth O
Canadian Orthopaedic Trauma Society, Halifax, Nova Scotia Canada.
J Orthop Trauma. 2014 Oct;28(10):577-83. doi: 10.1097/BOT.0000000000000191.
To compare long-term health outcome of Sanders type IV calcaneal fractures treated with open reduction and internal fixation (ORIF) versus ORIF plus primary subtalar arthrodesis (PSTA).
Randomized prospective multicenter trial.
Four Level 1 trauma hospitals in Canada.
Thirty-one patients with 31 Sanders IV displaced intraarticular calcaneal fractures.
Seventeen patients were treated with a standard protocol involving a lateral approach for ORIF. Fourteen patients were treated with a standard protocol involving a lateral approach with ORIF + PSTA.
Health outcomes were assessed with 4 validated instruments: (1) the Short Form 36 version 2 (SF-36), (2) the Musculoskeletal Functional Assessment Survey, (3) the American Orthopaedic Foot and Ankle Society's Ankle-Hindfoot Scale, and (4) the Visual Analogue Scale.
From 2004 to 2011, 26 patients (26 displaced intraarticular calcaneal fractures) were followed for a minimum of 2 years (81% follow-up). No statistical difference was found between the results for ORIF compared with ORIF + PSTA: the mean SF-36 physical component scores were, respectively, 30.2 (SD = 11.4) and 37.8 (SD = 10.4) (P = 0.10); the mean Musculoskeletal Functional Assessment Survey scores were 44.2 (SD = 25.6) and 37.9 (SD = 21.5) (P = 0.50); the mean Ankle-Hindfoot Scale scores were 62.5 (SD = 19.6) and 65.8 (SD = 19.2), (P = 0.68); and the mean Visual Analogue Scale scores were 36.8 (SD = 34.7) and 36.0 (SD = 30.7) (P = 0.82).
We were unable to demonstrate a significant difference between treating Sanders type IV fractures with either ORIF or ORIF + PSTA. It remains the choice of the surgeon and patient to take into account patient specific factors to determine treatment. However, ORIF + PSTA may be advantageous for both patients with Sanders type IV fractures and the health care system as patients heal quickly. Furthermore, ORIF + PSTA may prevent the need for late secondary subtalar fusion adding to increased costs and lost time from work.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
比较切开复位内固定术（ORIF）与ORIF联合一期距下关节融合术（PSTA）治疗Sanders IV型跟骨骨折的长期健康结局。
随机前瞻性多中心试验。
加拿大的四家一级创伤医院。
31例患者，共31处Sanders IV型移位关节内跟骨骨折。
17例患者采用标准方案治疗，通过外侧入路进行ORIF。14例患者采用标准方案治疗，通过外侧入路进行ORIF + PSTA。
使用4种经过验证的工具评估健康结局：（1）简明健康状况调查简表第2版（SF-36），（2）肌肉骨骼功能评估调查，（3）美国矫形足踝协会的踝-后足评分量表，以及（4）视觉模拟评分量表。
从2004年到2011年，26例患者（26处移位关节内跟骨骨折）接受了至少2年的随访（随访率81%）。ORIF组与ORIF + PSTA组的结果之间未发现统计学差异：SF-36身体成分平均得分分别为30.2（标准差 = 11.4）和37.8（标准差 = 10.4）（P = 0.10）；肌肉骨骼功能评估调查平均得分分别为44.2（标准差 = 25.6）和37.9（标准差 = 21.5）（P = 0.50）；踝-后足评分量表平均得分分别为62.5（标准差 = 19.6）和65.8（标准差 = 19.2）（P = 0.68）；视觉模拟评分量表平均得分分别为36.8（标准差 = 34.7）和36.0（标准差 = 30.7）（P = 0.82）。
我们无法证明ORIF与ORIF + PSTA治疗Sanders IV型骨折之间存在显著差异。外科医生和患者仍需考虑患者个体因素来决定治疗方案。然而，ORIF + PSTA可能对Sanders IV型骨折患者和医疗保健系统都有利，因为患者愈合更快。此外，ORIF + PSTA可能避免后期二期距下关节融合的需要，从而减少成本增加和工作时间损失。
治疗性II级。有关证据水平的完整描述，请参阅作者须知。
