Brand Andreas, Klöpfer-Krämer Isabella, Böttger Moritz, Kröger Inga, Gaul Leander, Wackerle Hannes, Müßig Janina Anna, Dietrich Andrea, Gabel Johannes, Augat Peter
Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria.
Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria.
Gait Posture. 2019 May;70:190-195. doi: 10.1016/j.gaitpost.2019.03.007. Epub 2019 Mar 12.
To overcome the substantial functional loss after calcaneal fractures (CF), surgical treatment currently consists of two strategies, namely the commonly used extended lateral approach (ELA) and the less invasive sinus tarsi approach (STA). Despite the comparable anatomical restoration, the biomechanical and functional outcome of these strategies during early rehabilitation has not yet been investigated.
To evaluate changes in gait characteristics and functional development in patients with CF treated by either STA or ELA.
A total of 56 patients with unilateral CF were included in this retrospective study. 26 patients were treated by ELA while 30 patients underwent surgery through the STA. Functional and biomechanical measurements were performed at follow-up periods of three and six months. Foot and ankle kinetics and kinematics were extracted using instrumented gait analysis with a multi segment foot model. Physical and mental components of the Short Form 36 (SF-36) and total scoring of the AOFAS hindfoot scale were used for functional evaluation. Statistical analysis was performed using Mann Whitney and Student's t-test. Effect sizes of group differences were calculated using Cohen's d.
Comparisons between ELA and STA showed no significant difference regarding the biomechanical and functional outcome. Within-group comparisons showed significant (p < 0.05) improvements from three to six month follow-up. Ankle joint and hindfoot kinematics showed increased mobility during walking of up to 34% and 26%, respectively. Maximum ankle joint moment also improved by up to 34% while vertical ground reaction force increased by 8%. Functional outcome only revealed significant changes in the physical component of SF-36.
ELA and STA treatments revealed comparable functional improvements in patients with unilateral intraarticular calcaneal fractures during early rehabilitation. The less invasive STA provides adequate restoration of dynamic foot function and could serve as a viable alternative to the commonly used ELA.
为克服跟骨骨折（CF）后严重的功能丧失，目前手术治疗有两种策略，即常用的扩大外侧入路（ELA）和微创距下关节入路（STA）。尽管解剖复位相当，但这些策略在早期康复期间的生物力学和功能结果尚未得到研究。
评估接受STA或ELA治疗的CF患者步态特征和功能发展的变化。
本回顾性研究共纳入56例单侧CF患者。26例患者接受ELA治疗，30例患者通过STA进行手术。在术后3个月和6个月的随访期进行功能和生物力学测量。使用多节段足部模型的仪器化步态分析提取足踝动力学和运动学数据。采用简明健康状况调查问卷（SF-36）的身体和心理成分以及美国足踝外科协会（AOFAS）后足评分的总分进行功能评估。采用曼-惠特尼检验和学生t检验进行统计分析。使用科恩d值计算组间差异的效应量。
ELA和STA之间的比较显示，在生物力学和功能结果方面无显著差异。组内比较显示，从3个月到6个月随访有显著（p<0.05）改善。踝关节和后足运动学显示，步行时活动度分别增加高达34%和26%。最大踝关节力矩也提高了高达34%，而垂直地面反作用力增加了8%。功能结果仅显示SF-36身体成分有显著变化。
ELA和STA治疗在单侧关节内跟骨骨折患者的早期康复中显示出相当的功能改善。微创STA能充分恢复足部动态功能，可作为常用ELA的可行替代方案。
