Investigation performed at the Department of Orthopaedic Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Investigation performed at the Department of Orthopaedic Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Injury. 2020 Aug;51(8):1910-1918. doi: 10.1016/j.injury.2020.03.063. Epub 2020 May 6.
This study aimed to determine whether bone density correlates with radiologic and clinical outcomes after screw fixation of displaced intra-articular calcaneal fractures (DIACF) with the sinus tarsi approach.
We retrospectively evaluated 43 consecutive cases of unilateral DIACF between March 2015 and December 2017. Radiologic evaluations were performed using preoperative, postoperative, and last follow-up calcaneal lateral and axial radiographs. In all patients, preoperative CT scanning of both injured and uninjured calcaneus were performed at one scanning and dual x-ray absorptiometry (DXA) scans were obtained. Hounsfield unit (HU) measurement values were determined by placing an elliptical region of interest confined to the cancellous region of the uninjured calcaneus. Clinical outcomes were assessed at a minimum of 12 months postoperatively using Foot and Ankle Outcome Scores (FAOS).
Mean HU values of the uninjured calcaneus significantly correlated with bone mineral density scores obtained from DXA scans of the lumbar and femur (Spearman ρ = 0.656 - 0.748; p < 0.001 for both). Decreased HU values of the uninjured calcaneus significantly correlated with decreased Böhler's angle and widening of calcaneal width from postoperative to last follow-up. (Pearson r = 0.348, p = 0.022; Pearson r = -0.582, p < 0.001, respectively). Increased HU values of the uninjured calcaneus significantly correlated with improved clinical outcomes in three of five FAOS domains, including activities of daily living, sports, and quality of life (beta = 0.283 - 0.322; p < 0.05 for all).
Decreased preoperative bone density significantly correlated with decreased Böhler's angle, widening of calcaneal width, and inferior short-term clinical outcomes after screw fixation of DIACF. By quantifying bone density using HU value in area where DXA cannot be performed, such foot bones, determining whether different fixation methods or systemic treatments can be tailored to bone density could help in optimizing clinical outcomes.
Level III, Retrospective case series.
本研究旨在探讨跟骨跗骨窦入路内固定治疗移位型关节内跟骨骨折（DIACF）后，骨密度与影像学和临床结果的相关性。
我们回顾性评估了 2015 年 3 月至 2017 年 12 月期间连续 43 例单侧 DIACF 患者。采用术前、术后及末次随访时的跟骨侧位和轴位 X 线片进行影像学评估。所有患者均行受伤和未受伤跟骨的术前 CT 扫描，并进行双能 X 线吸收仪（DXA）扫描。通过在未受伤跟骨的松质骨区域放置一个椭圆形感兴趣区来确定亨氏单位（HU）测量值。术后至少 12 个月采用足踝评分量表（FAOS）进行临床评估。
未受伤跟骨的平均 HU 值与 DXA 扫描腰椎和股骨的骨密度评分显著相关（Spearman ρ=0.656-0.748；p<0.001）。未受伤跟骨 HU 值降低与术后至末次随访时的 Böhler 角减小和跟骨宽度增宽显著相关（Pearson r=0.348，p=0.022；Pearson r=-0.582，p<0.001）。未受伤跟骨 HU 值增加与 FAOS 五个领域中三个领域（日常生活活动、运动和生活质量）的临床改善显著相关（β=0.283-0.322；p<0.05）。
术前骨密度降低与 Böhler 角减小、跟骨宽度增宽和内固定治疗 DIACF 后短期临床结果较差显著相关。通过在 DXA 无法进行的足部骨骼等部位使用 HU 值量化骨密度，确定不同的固定方法或全身治疗是否可以根据骨密度进行调整，有助于优化临床结果。
III 级，回顾性病例系列。
