Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.
Unit of Orthopaedics and Traumatology, Santa Maria della Speranza Hospital, Battipaglia, Italy.
Injury. 2019 Jul;50 Suppl 2:S70-S74. doi: 10.1016/j.injury.2019.01.049. Epub 2019 Feb 2.
Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. Minimally invasive percutaneous calcaneoplasty should be an alternative to ORIF aiming to reach a stable reduction, early functional recovery and short hospital stay. The aim of our study was to evaluate the clinical and radiographic outcomes of calcaneus fractures treated with balloon calcaneoplasty (BCP) by using a new generation vertebral augmentation system, VBS™-Vertebral Body Stent-DePuy Synthes. A total of 10 patients treated with VBS™ system were recruited for the study. Nine fractures were caused by a fall from height and one case by traffic accident. The mean follow-up was 8.9 months (range 2.6-23.1). The fractures were categorized according to Sanders and Essex-Lopresti classifications (5: type II, 3: type III and 2: type IV; 9: "joint depression" type and 1 case "tongue" type). Radiographic measurement (Böhler's and Gissane's angles) were evaluated at both pre-operative and immediate postoperative time. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score as well as a subjective evaluation (Visual Analog Scale, VAS) were used for the clinical assessment at the last follow-up. Mean preoperative Böhler's angle was 12.3 ± 8.41° (95% CI 6.3-18.3°), whereas mean preoperative Gissane's angle was 123.66 ± 20.47° (95% CI 109.0-138.3°). At postoperative follow-up mean Böhler's angle increased to 21.51 ± 4.17° (95% CI 18.5-24.5°; p < 0.01), and mean postoperative Gissane's angle was 121.74°±6.82° (95% CI 116.8°-126.6°). Mean AOFAS at the last follow-up was 70.4 ± 17.44 (95% CI 57.9-82.8). Our study demonstrates that percutaneous calcaneoplasty using VBS™ is an effective treatment for calcaneus fracture and capable to implement correction manoeuvre with clinical and radiographic outcomes comparable with other percutaneous stentoplasty.
跟骨是后足骨折最常见的部位，常由高处坠落或高能创伤引起。治疗策略从非手术到切开复位内固定（ORIF）不等。经皮固定的适应证包括软组织损伤或相对禁忌切开手术。微创经皮跟骨成形术（BCP）应作为 ORIF 的替代方法，旨在实现稳定复位、早期功能恢复和缩短住院时间。我们的研究目的是评估使用新一代椎体增强系统 VBS™-Vertebral Body Stent-DePuy Synthes 治疗跟骨骨折的临床和影像学结果。共有 10 例患者接受了 VBS™系统治疗，纳入本研究。9 例骨折由高处坠落引起，1 例由交通事故引起。平均随访 8.9 个月（范围 2.6-23.1）。骨折根据桑德斯和埃塞克斯-洛普雷斯特分类（5 型：II 型，3 型：III 型，2 型：IV 型；9 型：“关节凹陷”型，1 例“舌”型）进行分类。在术前和术后即刻进行影像学测量（博勒角和吉桑角）。在最后一次随访时，使用美国矫形足踝协会（AOFAS）踝关节-后足评分以及主观评估（视觉模拟评分，VAS）进行临床评估。术前平均博勒角为 12.3±8.41°（95%CI 6.3-18.3°），术前平均吉桑角为 123.66±20.47°（95%CI 109.0-138.3°）。术后随访时，平均博勒角增加至 21.51±4.17°（95%CI 18.5-24.5°；p<0.01），平均术后吉桑角为 121.74°±6.82°（95%CI 116.8°-126.6°）。最后一次随访时平均 AOFAS 为 70.4±17.44（95%CI 57.9-82.8）。我们的研究表明，使用 VBS™进行经皮跟骨成形术是治疗跟骨骨折的有效方法，能够实施矫正操作，临床和影像学结果可与其他经皮支架成形术相媲美。
