Law Gin Way, Yeo Nicholas Eng Meng, Yeo William, Koo Kevin, Chong Keen Wai
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
J Orthop Surg (Hong Kong). 2017 Jan;25(1):2309499016684995. doi: 10.1177/2309499016684995.
Percutaneous fixation of intra-articular calcaneal fractures is traditionally assisted only by intraoperative fluoroscopy. Previous studies have demonstrated that the additional use of subtalar arthroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint for less complex calcaneal fractures yielded positive results up to 2-year follow-up. This study aims to investigate long-term outcomes of these patients using similar evaluation parameters. We hypothesized that this novel technique with dual-imaging can provide sustainable, long-term benefits with good functional outcomes and significant restoration of the Bohler's angle.
We performed a retrospective study of 15 Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures in 14 patients who underwent subtalar arthroscopy and fluoroscopy guided percutaneous fracture fixation with a minimum follow-up of 5 years. Outcome measures were assessed using the ankle and hindfoot NPRS, AOFAS ankle-hindfoot score, and SF-36 Physical Function subscale preoperatively and at 3 months, 6 months, 1 year, 2 years and 5-8 years postoperatively. The Bohler's angle was measured preoperatively, immediately postoperatively and at 5-8 years postoperatively.
We report excellent functional outcomes in all scores as well as continued improvements in the majority of patients across all time points with minimal subsidence of the corrected Bohler's angle over our study time frame.
Subtalar arthroscopy with intraoperative fluoroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint is most useful in Sanders type II, AO-OTA 83-C2 fractures with excellent functional outcomes and good preservation of the corrected Bohler's angle on long-term follow-up.
传统上，跟骨关节内骨折的经皮固定仅在术中透视辅助下进行。先前的研究表明，对于不太复杂的跟骨骨折，在距下关节后关节面解剖复位中额外使用距下关节镜检查，在长达2年的随访中取得了积极的结果。本研究旨在使用类似的评估参数调查这些患者的长期结果。我们假设这种双成像新技术可以提供可持续的长期益处，具有良好的功能结果和显著恢复的跟骨角。
我们对14例患者的15例Sanders II型、AO-OTA 83-C2型跟骨关节内骨折进行了回顾性研究，这些患者接受了距下关节镜检查和透视引导下的经皮骨折固定，随访时间至少为5年。术前以及术后3个月、6个月、1年、2年和5 - 8年，使用踝关节和后足NPRS、AOFAS踝 - 后足评分以及SF - 36身体功能子量表评估结果指标。术前、术后即刻以及术后5 - 8年测量跟骨角。
我们报告所有评分的功能结果都非常出色，并且在所有时间点，大多数患者都持续改善，在我们的研究时间范围内矫正后的跟骨角仅有最小程度的塌陷。
在距下关节后关节面解剖复位中，术中透视下的距下关节镜检查对Sanders II型、AO-OTA 83-C2型骨折最为有用，长期随访时功能结果优异，矫正后的跟骨角保存良好。
