Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
Injury. 2019 Aug;50 Suppl 3:63-68. doi: 10.1016/j.injury.2019.07.015. Epub 2019 Aug 1.
Surgical treatment of displaced intra-articular calcaneal fractures using a standard extended lateral approach for plate fixation is frequently associated with substantial wound healing complications and infections. This matched pairs analysis compares the new minimally-invasive calcaneal interlocking nailing technique to standard locking plate fixation in terms of reduction capacity, complication rates, and functional outcomes.
Forty feet in 38 patients (mean patient age 52.5 years, range 27-78) were treated with calcaneal locking nail (LN)(n=20) or locking plate (LP)(n=20) and followed clinically and radiologically for 20 months. Follow-up included radiological assessments and functional evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Foot Function Index (R-FFI).
Times for surgery were similar for both techniques (LN 93min, range 34 to 175 vs. LP 101min, range 53 to 305). Length of hospital stay was significantly lower in the LN group (7.6 days, range 3 to 14 vs. LP 11 days, range 6 to 37). Time away from work was shorter by 3.5 days in LN group. LP group had superior range of motion in plantarflexion, eversion, and inversion at follow-up, while LP patients were superior in demonstrating a secure heelstrike (79% vs. LN 58%) and fewer needed permanent walking aids. AOFAS and FFI scores revealed no differences for both groups. Radiographs indicated an adequate reconstruction in both groups, followed by a slight loss of reduction at follow-up (LP 4.7° postoperative vs. follow-up; LN 5.1°). The overall complication rate between groups was significant with 5% complications in the LN group vs. 50% in the LP group (5% deep infection, 35% impaired wound healing, 5% hardware breakage, 5% superficial wound infection; LN: 5% superficial wound infection).
The new calcaneal interlocking nail shows promising results in terms of reduction capacity and safety. Use of the minimally invasive locking nail technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach.
使用标准的外侧延长入路进行钢板固定治疗移位的关节内跟骨骨折，常伴有严重的伤口愈合并发症和感染。本配对分析比较了新的微创跟骨自锁钉技术与标准锁定钢板固定在复位能力、并发症发生率和功能结果方面的差异。
38 名患者（平均年龄 52.5 岁，范围 27-78 岁）的 40 只脚接受了跟骨锁定钉（LN）（n=20）或锁定钢板（LP）（n=20）治疗，并进行了 20 个月的临床和放射学随访。随访包括影像学评估和功能评估，包括美国矫形足踝协会（AOFAS）踝-后足评分和足部功能指数（R-FFI）。
两种技术的手术时间相似（LN 93min，范围 34-175 vs. LP 101min，范围 53-305）。LN 组的住院时间明显更短（7.6 天，范围 3-14 天 vs. LP 组 11 天，范围 6-37 天）。LN 组的工作缺勤时间减少了 3.5 天。LP 组在随访时的跖屈、外翻和内翻活动范围更大，而 LP 患者在表现出安全的足跟触地（79% vs. LN 58%）和更少需要永久性助行器方面更具优势。AOFAS 和 FFI 评分显示两组之间没有差异。X 线片显示两组均有足够的重建，随后随访时出现轻微的复位丢失（LP 术后 4.7°，随访时 5.1°）。两组之间的总体并发症发生率有显著差异，LN 组为 5%，LP 组为 50%（深部感染 5%，伤口愈合不良 35%，内固定物断裂 5%，浅表伤口感染 5%；LN 组：浅表伤口感染 5%）。
新的跟骨自锁钉在复位能力和安全性方面表现出良好的效果。与标准的外侧延长入路的锁定钢板固定相比，微创自锁钉技术的使用降低了术后伤口并发症的风险，并获得了更好的功能结果。
