Harnroongroj T, Jiamamornrat S, Tharmviboonsri T
Department of Orthopaedics and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Orthopaedics and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Foot Ankle Surg. 2019 Jun;25(3):323-326. doi: 10.1016/j.fas.2017.12.009. Epub 2017 Dec 24.
Minimal invasive surgery of calcaneal fracture provided satisfactory outcomes. In tongue type calcaneal fracture, percutaneous screw usually purchases in anterior inferior calcaneal cortex. However, there was no detail about the cortex of anterior inferior calcaneus so the surface anatomy and cortical thickness of this area were studied.
88 calcaneus from embalmed cadavers were enrolled. Anterior part of the inferior cortex was identified. Surface anatomy was examined. Length, anterior and posterior widths were measured. Anterior inferior calcaneal cortex was divided into anterior, middle and posterior segments. The cortical thickness at middle, medial most and lateral most of 3 segments were measured.
Anterior inferior calcaneal cortex was a long trapezoidal shape with well-defined borders as a dense and thick cortical bone, convex relief from medial and lateral walls. Mean(SD) length was 33.40(3.46) millimeters (mm). Median(min,max) of anterior and posterior width were 10.50(8.21,19.26) mm and 14.00(10.05,20.42) mm, respectively. Mean(SD) of middle cortical thickness of anterior and middle segment were 3.12(0.76) and 3.72(0.74). Median(min,max) middle cortical thickness of posterior segment was 3.13(1.62,6.51) mm. Whereas, of the medial most were 1.31(0.78,3.11), 1.31(0.90,2.57) and 1.26(0.85,2.61) mm and of the lateral most were 1.17(0.67,2.64), 1.38(0.80,2.55) and 1.31(0.84,2.61) mm, respectively. Inter-intraobserver reliabilities of the measurements were >0.79. The statistical analysis showed the middle cortex is significantly the thickest (P<0.001) and posterior width is significant wider than the anterior (P<0.001).
Anterior inferior calcaneal cortex has special characteristics in term of surface anatomy, width and thickness. For the percutaneous screw insertion from posterosuperior to anterior inferior calcaneus in tongue type calcaneal fracture, we recommend that screw should purchase in middle cortex due to maximal cortical thickness as well as its cortical width could accept 6.5 or 7.0mm screw without screw extrusion.
跟骨骨折的微创手术取得了令人满意的效果。在舌型跟骨骨折中，经皮螺钉通常固定于跟骨前下皮质。然而，关于跟骨前下皮质的细节尚无报道，因此对该区域的表面解剖结构和皮质厚度进行了研究。
纳入88例防腐尸体的跟骨。确定下皮质的前部。检查表面解剖结构。测量长度、前后宽度。将跟骨前下皮质分为前、中、后段。测量3个节段中间、最内侧和最外侧的皮质厚度。
跟骨前下皮质呈长梯形，边界清晰，为致密增厚的皮质骨，从内侧和外侧壁向外凸出。平均（标准差）长度为33.40（3.46）毫米（mm）。前后宽度的中位数（最小值，最大值）分别为10.50（8.21，19.26）mm和14.00（10.05，20.42）mm。前、中段中间皮质厚度的平均（标准差）分别为3.12（±0.76）和3.72（±0.74）。后段中间皮质厚度的中位数（最小值，最大值）为3.13（1.62，6.51）mm。而最内侧分别为1.31（0.78，3.11）、1.31（0.90，2.57）和1.26（0.85，2.61）mm，最外侧分别为1.17（0.67，2.64）、1.38（0.80，2.55）和1.31（0.84，2.61）mm。测量的观察者间和观察者内信度均>0.79。统计分析表明，中间皮质明显最厚（P<0.001），后宽度明显宽于前宽度（P<0.001）。
跟骨前下皮质在表面解剖、宽度和厚度方面具有特殊特征。对于舌型跟骨骨折从后上向前下置入经皮螺钉时,我们建议螺钉应固定于中间皮质，因其皮质厚度最大，且其皮质宽度可容纳6.5或7.0mm螺钉而不会出现螺钉穿出。
