Wang Chen, Huang Dichao, Ma Xin, Wang Xu, Huang Jiazhang, Zhang Chao, Chen Li, Geng Xiang
Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China.
J Orthop Surg Res. 2017 May 30;12(1):78. doi: 10.1186/s13018-017-0580-5.
The sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. Currently, the screw is still inserted based on surgeons' anatomical experiences and nearly 40% of screws are misplaced from the sustentaculum. Previous studies demonstrated some methods of sustentacular screw placement through anatomical measurements or navigation system. The purposes of this study are to design an assistant guidance device that can effectively improve the accuracy of sustentacular screw placement and to compare the accuracy of this technique with traditional screw placement based on experience.
A customized guidance device is designed, aiming to improve the accuracy of sustentacular screw placement. Twenty cadaveric specimens are used in the present study. Ten specimens are allocated into the guidance-assisted group, and others are included in the traditional screw insertion group. A total of 40 sustentacular screw placements are performed in each group. Fluoroscopic images are obtained after each screw placement. Only the screw that captures the sustentaculum both on the lateral and axial X-ray views was regarded as an accurate placement.
The accuracy rate in the guidance-assisted group is 87.5% (35 out of 40 times of insertions) while in the traditional screw insertion group, the accuracy rate is 65% (26 out of 40 times of insertions). A significant difference is found between the two groups (p = 0.018).
The guidance-assisted technique is a convenient approach that can effectively improve the accuracy of sustentacular screw placement during the ORIF of calcaneal fractures. This study provides a novel technique that significantly facilitates sustentacular screw insertion and improves its accuracy.
在跟骨骨折切开复位内固定术（ORIF）中，支撑螺钉对于维持距下关节的稳定性至关重要。目前，该螺钉仍基于外科医生的解剖学经验进行置入，近40%的螺钉会偏离载距突。先前的研究展示了一些通过解剖测量或导航系统进行支撑螺钉置入的方法。本研究的目的是设计一种辅助引导装置，以有效提高支撑螺钉置入的准确性，并将该技术的准确性与基于经验的传统螺钉置入方法进行比较。
设计了一种定制的引导装置，旨在提高支撑螺钉置入的准确性。本研究使用了20个尸体标本。10个标本被分配到引导辅助组，其他标本被纳入传统螺钉置入组。每组共进行40次支撑螺钉置入。每次螺钉置入后获取荧光透视图像。只有在侧位和轴位X线片上均捕捉到载距突的螺钉才被视为准确置入。
引导辅助组的准确率为87.5%（40次置入中有35次），而在传统螺钉置入组中，准确率为65%（40次置入中有26次）。两组之间存在显著差异（p = 0.018）。
引导辅助技术是一种简便的方法，可有效提高跟骨骨折切开复位内固定术中支撑螺钉置入的准确性。本研究提供了一种新技术，显著便于支撑螺钉的置入并提高了其准确性。
