Simon P, Goldzak M, Eschler A, Mittlmeier T
Centre hospitalier Saint Joseph Saint Luc, 20 Quai Claude Bernard, 69365, Lyon Cedex 07, France.
Clinique de l'Union, 31240, Saint Jean, France.
Int Orthop. 2015 Oct;39(10):2061-7. doi: 10.1007/s00264-015-2816-5. Epub 2015 Jul 8.
The best treatment for intra-articular fractures of the calcaneus is still debated. The aims of this study were to determine whether intrafocal reduction of thalamic fractures is effective, to evaluate whether a locking nail is able to maintain reduction of the articular surface and to analyse the functional results of this original method.
This prospective study assessed 69 fractures treated with a locking fracture nail in 63 cases and with primary subtalar fusion in six (Calcanail (®), FH). Articular congruity and global reduction of the calcaneus was assessed in all patients by computed tomography (CT) scan three months postoperatively. Functional results were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and all complications recorded.
For the 63 fracture nails, the average AOFAS score was 85.9 at a mean final follow-up of 12 months. Only three secondary fusions were performed. For the six comminuted fractures requiring primary fusion, the average AOFAS score was 75.9 at the last follow-up.
The posterior intrafocal approach for both reduction and locked nailing of intra-articular calcaneal fractures has been proven as an effective and reliable procedure.
跟骨关节内骨折的最佳治疗方法仍存在争议。本研究的目的是确定丘脑骨折的病灶内复位是否有效，评估锁定钉能否维持关节面的复位，并分析这种原始方法的功能结果。
这项前瞻性研究评估了63例采用锁定骨折钉治疗的69处骨折，以及6例采用一期距下关节融合术治疗的骨折（Calcanail（®），FH）。所有患者在术后三个月通过计算机断层扫描（CT）评估跟骨的关节一致性和整体复位情况。根据美国矫形足踝协会踝-后足评分（AOFAS-AHS）评估功能结果，并记录所有并发症。
对于63枚骨折钉，在平均末次随访12个月时，平均AOFAS评分为85.9。仅进行了3例二次融合术。对于6例需要一期融合的粉碎性骨折，末次随访时平均AOFAS评分为75.9。
关节内跟骨骨折的病灶内复位及锁定钉固定的后路方法已被证明是一种有效且可靠的手术方法。
