Mahmoud Karim, Mekhaimar Mohamed Maged, Alhammoud Abduljabbar
Orthopedics Resident, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Senior Consultant Orthopedics, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
J Foot Ankle Surg. 2018 May-Jun;57(3):572-578. doi: 10.1053/j.jfas.2017.11.032. Epub 2018 Mar 14.
Peroneal tendon instability associated with an intraarticular calcaneal fracture is a common injury that still often passes undiscovered by both radiologists and orthopedic surgeons. Timely identification of this injury will guide the choice of surgical technique used and treatment of patients. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, several databases were searched through June 2017 for any observational or experimental studies that reported the prevalence/incidence of peroneal tendon subluxation/dislocation with a calcaneus fracture with regard to fracture classifications and the significance of the fleck sign. Nine studies were included, with 1027 patients and 1050 calcaneus fractures. The overall prevalence of peroneal instability (PI) in association with a calcaneus fracture was 29.3%. An increasing prevalence of PI increased the severity of the calcaneus fractures, 5.4% in Sanders I, 19% in Sanders II, 39.4% in Sanders III, and 49.5% in Sanders IV. The presence of a fleck sign is a strong indicator of PI, with a prevalence of 54.7%. The computed tomography findings can overestimate the presence of PI compared with the intraoperative findings. The global reported prevalence of peroneal tendon instability associated with intraarticular calcaneal fractures is high and increases with increasing severity of the calcaneus fracture.
与关节内跟骨骨折相关的腓骨肌腱不稳定是一种常见损伤，放射科医生和骨科医生常常未能及时发现。及时识别这种损伤将指导手术技术的选择和患者的治疗。按照系统评价和Meta分析的首选报告项目指南，检索了多个数据库，截至2017年6月，查找任何观察性或实验性研究，这些研究报告了跟骨骨折合并腓骨肌腱半脱位/脱位的患病率/发病率，涉及骨折分类和斑点征的意义。纳入了9项研究，共1027例患者和1050例跟骨骨折。跟骨骨折合并腓骨不稳定（PI）的总体患病率为29.3%。PI患病率的增加与跟骨骨折的严重程度增加相关，Sanders I型为5.4%，Sanders II型为19%，Sanders III型为39.4%，Sanders IV型为49.5%。斑点征的出现是PI的有力指标，患病率为54.7%。与术中发现相比，计算机断层扫描结果可能高估PI的存在。全球报告的关节内跟骨骨折合并腓骨肌腱不稳定的患病率较高，且随跟骨骨折严重程度的增加而增加。
