Correoso Castellanos S, García Galvez A, Lajara Marco F, Blay Dominguez E
Hospital Vega Baja, Orihuela, Alicante, España.
Hospital Vega Baja, Orihuela, Alicante, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2019 Nov-Dec;63(6):383-388. doi: 10.1016/j.recot.2019.05.003. Epub 2019 Aug 23.
Since the development of locking plates, calcaneal fractures have been considered ideal for this type of fixation, due to the need to maintain the height of the subastragaline joint after depression fractures in a location where bone quality tends to be poor. However, there are no comparative studies that support the theoretical superiority of these plates over conventional plates. The aim of this study was to compare the results of intraarticular calcaneal fractures treated using locking plates vs. conventional plates in terms of radiological reduction, complications and number of reinterventions.
We designed a comparative study of calcaneal fractures operated in our centre using the "L" approach. Two groups were established: group B, comprising 15 patients operated between 2010 and 2015 with calcaneal locking plates, and group A, comprising a stratified random sample of 23 patients taken from a historical cohort of 90 patients operated in our centre between 1997 and 2007 using conventional calcaneal plates. Demographic data were recorded (age, sex, diabetes mellitus, smoking) and data relating to the fracture (type of fracture according to Sander's classification system, complications, presurgical delay). To evaluate loss of reduction, varus angulation of the calcaneus (measured from the axial view), Böhler's angle and Gissane's angle were assessed radiographically. These angles were measured preoperatively, immediately postoperatively, and at the end of follow-up. Finally, we recorded complications and the number of reinterventions.
There were no differences in terms of age, sex or fracture type between the 2 groups. There was greater loss of varus angulation in group A, 0.6 vs. 0.41°, and there was greater reduction in Böhler's angle in group A, 3.79 vs. 2.6°, while Gissane's angle decreased more in group B, 4.13 vs. 2.52°. There were no significant differences in the proportion of complications and reinterventions between the 2 groups.
In our study we observed no significant differences between the 2 groups in terms of radiological reduction, complications or number of reinterventions. However, we did observe a greater loss of reduction of Böhler's angle in the patients who were operated using conventional plates.
自锁定钢板问世以来，由于在骨质往往较差的部位发生塌陷骨折后需要维持距下关节的高度，跟骨骨折一直被认为是这种固定方式的理想适应症。然而，尚无比较研究支持这些钢板相对于传统钢板的理论优势。本研究的目的是比较使用锁定钢板与传统钢板治疗关节内跟骨骨折在放射学复位、并发症及再次干预次数方面的结果。
我们设计了一项对在本中心采用“L”形入路手术治疗的跟骨骨折进行的比较研究。设立了两组：B组，包括2010年至2015年间使用跟骨锁定钢板手术的15例患者；A组，包括从1997年至2007年间在本中心使用传统跟骨钢板手术的90例患者的历史队列中分层随机抽取的23例患者。记录人口统计学数据（年龄、性别、糖尿病、吸烟情况）以及与骨折相关的数据（根据桑德分类系统的骨折类型、并发症、术前延迟时间）。为评估复位丢失情况，通过X线片测量跟骨的内翻角度（从轴位视图测量）、Böhler角和Gissane角。这些角度在术前、术后即刻及随访结束时进行测量。最后，我们记录并发症及再次干预次数。
两组在年龄、性别或骨折类型方面无差异。A组内翻角度丢失更多，为0.6°对0.41°，A组Böhler角减小更多，为3.79°对2.6°，而B组Gissane角减小更多，为4.13°对2.52°。两组在并发症及再次干预比例方面无显著差异。
在我们的研究中，两组在放射学复位、并发症或再次干预次数方面未观察到显著差异。然而，我们确实观察到使用传统钢板手术的患者中Böhler角的复位丢失更大。
