Eckardt Henrik, Lind Marianne
Department of Traumatology, Basel University Hospital, Basel, Switzerland
Department of Orthopaedic Traumatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Foot Ankle Int. 2015 Jul;36(7):764-73. doi: 10.1177/1071100715576518. Epub 2015 Mar 11.
Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures, resulting in improved articular congruence and implant positioning.
Sixty-two displaced calcaneal fractures were operated on using standard fluoroscopic views. When the surgeon had achieved a satisfactory reduction, an intraoperative 3D scan was conducted, malreductions or implant imperfections were revised, the calcaneus was rescanned, and this sequence was repeated until the optimal operative result was achieved.
Five fractures underwent 1 intraoperative scan, 39 fractures underwent 2 scans, 13 fractures underwent 3 scans, and 5 fractures underwent 4 scans. The average number of scans was 2.3. Intraoperative scanning led to re-reduction and improvement of reduction in 13 fractures, change of plate position in 1 patient, optimizing of the screw directions in 5 fractures, and shortening of screws that were intra-articular or protruding medially in 6 fractures. The postoperative articular displacement was 0 mm in 69% of the Sanders type 2 fractures and 57% of the Sanders type 3 fractures. Operation duration averaged 118 minutes, and there were no reoperations due to misplaced screws or plates. The average absorbed radiation dose per patient was 288 mGy·cm.
Intraoperative 3D imaging improved the articular reduction of the posterior facet and secured optimal implant position in displaced calcaneal fractures. Radiation dose to the patient was less than that of a normal foot computed tomography scan.
Level IV, case series.
移位跟骨骨折的手术治疗应恢复关节的一致性，但传统的荧光透视无法完全观察距下关节。我们质疑术中三维（3D）成像是否有助于跟骨骨折的复位，从而改善关节一致性和植入物定位。
对62例移位跟骨骨折采用标准荧光透视视图进行手术。当外科医生达到满意的复位后，进行术中3D扫描，修正复位不良或植入物缺陷，重新扫描跟骨，并重复该过程，直到获得最佳手术效果。
5例骨折进行了1次术中扫描，39例骨折进行了2次扫描，13例骨折进行了3次扫描，5例骨折进行了4次扫描。平均扫描次数为2.3次。术中扫描导致13例骨折再次复位并改善了复位情况，1例患者的钢板位置改变，5例骨折的螺钉方向得到优化，6例骨折的关节内或内侧突出螺钉缩短。69%的Sanders 2型骨折和57%的Sanders 3型骨折术后关节移位为0 mm。手术平均持续时间为118分钟，没有因螺钉或钢板位置不当而进行再次手术。每位患者的平均吸收辐射剂量为288 mGy·cm。
术中3D成像改善了后关节面的关节复位，并确保了移位跟骨骨折植入物的最佳位置。患者接受的辐射剂量低于正常足部计算机断层扫描。
IV级，病例系列。
