Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 200120 Shanghai, China.
Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 200120 Shanghai, China.
Int J Surg. 2015 Jul;19:72-7. doi: 10.1016/j.ijsu.2015.05.011. Epub 2015 May 14.
Correct placement of the sustentacular screw is an important component during the open reduction and internal fixation of calcaneal fractures. The hypothesis of this study is that certain 3D-CT images would help detect the real placement of the sustentaculum screw. The aims of the study are to investigate the postoperative status of the sustentacular screw and to evaluate the effect of the sustentaculum screw placement on the treatment of intra-articular calcaneal fractures.
119 patients with intra-articular calcaneal fractures meeting the inclusion criteria were included in this prospective study. The postoperative sustentaculum screw was detected via radiographs and CT scans. According to the placement of the screw, the patients were divided into three groups: the sustentaculum screw with accurate fixation (group A), marginal fixation (group B), and non-fixation (group C). The perioperative parameters and the change of Böhler's angles on the postoperative and final follow-up radiographs were analyzed. The clinical outcomes were evaluated by the AOFAS ankle-hindfoot score and Short Form-36 questionnaire.
Eighty-five patients were followed up with an average time of 26 (range, 12-48) months. 3D-CT confirmed that 18 cases were in group A, 33 in group B, and 34 in group C. Except the length of stay, significant difference in the operating time and blood loss existed among three groups (P < 0.05). The mean decrease in Böhler's angle of group C was the greatest (P < 0.05). No significant difference could be detected in the AOFAS or SF-36 scores among the three groups either at the one-year follow-up or the final follow-up (P > 0.05).
The sustentaculum screw with non-fixation may cause the decrease of Böhler's angle throughout the follow-up. The clinical outcomes were similar whether the screw was accurately placed within the sustentaculum or not.
在跟骨骨折切开复位内固定术中，正确放置距骨支撑螺钉是一个重要的环节。本研究的假设是某些 3D-CT 图像可以帮助检测到距骨支撑螺钉的实际位置。本研究的目的是探讨术后距骨支撑螺钉的状态，并评估距骨支撑螺钉的放置对治疗关节内跟骨骨折的影响。
本前瞻性研究纳入了 119 例符合纳入标准的关节内跟骨骨折患者。术后通过 X 线和 CT 扫描检测距骨支撑螺钉。根据螺钉的位置，将患者分为三组：螺钉固定准确（A 组）、边缘固定（B 组）和未固定（C 组）。分析围手术期参数和术后及最终随访 X 线片上 Bohler 角的变化。采用美国足踝外科协会（AOFAS）踝-后足评分和 36 项简明健康调查问卷（SF-36）评估临床疗效。
85 例患者获得平均 26 个月（12-48 个月）的随访。3D-CT 证实 A 组 18 例，B 组 33 例，C 组 34 例。除了住院时间外，三组之间的手术时间和失血量差异有统计学意义（P<0.05）。C 组的 Bohler 角平均下降幅度最大（P<0.05）。三组患者在 1 年随访和最终随访时的 AOFAS 和 SF-36 评分差异均无统计学意义（P>0.05）。
未固定的距骨支撑螺钉可能会导致整个随访过程中 Bohler 角的下降。螺钉是否准确放置在距骨支撑内，对临床疗效没有影响。
