Saxena Amol, Patel Rajan
Podiatrist, Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA.
Former Fellow, Palo Alto Medical Foundation, Palo Alto, CA.
J Foot Ankle Surg. 2016 Nov-Dec;55(6):1164-1168. doi: 10.1053/j.jfas.2016.06.006. Epub 2016 Sep 15.
Locking plate fixation is becoming more popular for fixation of lower extremity osteotomies. The present study evaluated locking plate fixation compared with screw fixation in the medial displacement calcaneal osteotomy procedure, measuring the outcomes and rate of hardware removal. The procedure was performed on 30 patients, 31 times, with 17 undergoing single screw fixation and 14 undergoing locking plate fixation. The return to activity was 6.87 ± 1.43 months, including some patients for whom running was their main activity. No malunions, nonunions, displacements, or infections developed. In 3 patients (21.4%), the locking plate was removed compared with 1 patient (5.9%) who required screw removal. The difference was not significant (p = .30). No differences were found in their postoperative American Orthopaedic Foot and Ankle Scale scores (91.9 ± 7.7 with plates versus 94.4 ± 5.8 with screws; p = .36). The Roles and Maudsley scores were the same in the 2 groups preoperatively at 4.0 ± 0.0, with the postoperative scores improving to 1.50 ± 0.5 and 1.41 ± 0.5 for the plate and screw group, respectively (p = .62). No significant increase was seen for patients undergoing hardware removal, regardless of the adjunctive procedure used (i.e., flexor digitorum longus/Kidner, Lapidus or midfoot fusion, subtalar arthroereisis, and endoscopic gastrocnemius recession). The stage of posterior tibialis dysfunction had no significant difference in the postoperative scores. From the results of the present study, we have concluded that using a locking plate or a single screw for fixation of the medial displacement calcaneal osteotomy provides acceptable patient outcomes and that the differences in the rate of hardware removal were not statistically significant between the 2 groups.
锁定钢板固定在下肢截骨术固定中越来越受欢迎。本研究评估了在跟骨内侧移位截骨手术中锁定钢板固定与螺钉固定的效果，并测量了内固定取出率。该手术共对30例患者进行了31次，其中17例接受单螺钉固定，14例接受锁定钢板固定。恢复活动的时间为6.87±1.43个月，其中包括一些以跑步为主要活动的患者。未出现畸形愈合、骨不连、移位或感染情况。3例（21.4%）患者取出了锁定钢板，而需要取出螺钉的患者为1例（5.9%）。差异无统计学意义（p = 0.30）。两组术后美国矫形足踝协会评分无差异（钢板组为91.9±7.7，螺钉组为94.4±5.8；p = 0.36）。两组术前的罗尔斯和莫兹利评分均为4.0±0.0，术后钢板组和螺钉组的评分分别提高到1.50±0.5和1.41±0.5（p = 0.62）。无论采用何种辅助手术（即趾长屈肌/基德纳手术、拉皮德斯手术或中足融合术、距下关节撑开术以及内镜下腓肠肌松解术），接受内固定取出的患者均未出现显著增加。胫后肌功能障碍阶段的术后评分无显著差异。根据本研究结果，我们得出结论，在跟骨内侧移位截骨术中使用锁定钢板或单螺钉固定均可为患者提供可接受的治疗效果，且两组在内固定取出率上的差异无统计学意义。
