Park Chul Hyun, Yoon Doo Hyung
1 Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.
Foot Ankle Int. 2018 Apr;39(4):443-449. doi: 10.1177/1071100717746181. Epub 2018 Jan 28.
This study was conducted to evaluate the usefulness of subtalar arthroscopy in the operative treatment of Sanders type 2 calcaneus fractures using a sinus tarsi approach.
Forty-six Sanders type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach. Intraoperative fluoroscopy was used to evaluate fracture reduction in the first 23 patients (fluoroscopy group), and intraoperative fluoroscopy and subtalar arthroscopy were used in the latter 23 patients (arthroscopy group). Clinical evaluations were performed using a visual analog scale, the Ankle-Hindfoot Scale developed by the American Orthopaedic Foot & Ankle Society, and Short Form Health Survey. Radiographic evaluations were performed using calcaneal and lateral radiographs and computed tomography (CT) scans. Böhler's angles and calcaneal widths were compared between the groups. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet on CT.
At the last follow-up, clinical results as well as Böhler's angles and calcaneal widths were not different between the groups. On immediately postoperative CT, reduction of the posterior facet showed a higher-than-good grade in 17 feet (73.9%) in the fluoroscopy group and a higher-than-good grade in 22 feet (95.7%) in the arthroscopy group, and these values were significantly different between the groups ( P = .04).
A combined approach using fluoroscopy and subtalar arthroscopy showed better reduction of the posterior facet on CT than using fluoroscopy alone. Therefore, subtalar arthroscopy could be a useful method for detecting joint incongruence when using the sinus tarsi approach for Sanders type 2 calcaneal fractures.
Level III, comparative series.
本研究旨在评估经跗骨窦入路距下关节镜在Sanders Ⅱ型跟骨骨折手术治疗中的应用价值。
连续采用跗骨窦入路治疗46例Sanders Ⅱ型跟骨骨折。前23例患者术中使用透视评估骨折复位情况（透视组），后23例患者术中同时使用透视和距下关节镜（关节镜组）。采用视觉模拟评分法、美国足踝协会制定的踝-后足评分量表以及健康调查简表进行临床评估。采用跟骨侧位X线片和计算机断层扫描（CT）进行影像学评估。比较两组的Böhler角和跟骨宽度。根据CT上后关节面的关节台阶、缺损和角度对后关节面的复位情况进行分级。
末次随访时，两组的临床结果、Böhler角和跟骨宽度无差异。术后即刻CT显示，透视组17足（73.9%）后关节面复位高于良好等级，关节镜组22足（95.7%）后关节面复位高于良好等级，两组间差异有统计学意义（P = 0.04）。
与单纯使用透视相比，透视联合距下关节镜入路在CT上对后关节面的复位效果更好。因此，在采用跗骨窦入路治疗Sanders Ⅱ型跟骨骨折时，距下关节镜可能是检测关节不平整的有效方法。
Ⅲ级，对比系列研究。
