Zheng Gang, Xia Fan, Yang Shuang, Cui Jun
Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China.
World J Clin Cases. 2020 Oct 6;8(19):4400-4409. doi: 10.12998/wjcc.v8.i19.4400.
There are many types of treatments for calcaneal fractures, including conservative treatment, conventional surgical treatment, and minimally invasive surgery. The choice of specific treatment options is still controversial. Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic. A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus; however, many studies have reported a high incidence of postoperative incision complications. Although there are many methods for the classification of intra-articular calcaneal fractures, it is generally believed that the computed tomography (CT) classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures. However, this method has no clear guiding significance for the choice of surgical incision and surgical plan.
To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.
From July 2017 to July 2018, 91 patients, including 60 males and 31 females aged 27 to 60 years, were enrolled. All participants had closed intra-articular calcaneal fracture, and their surgical options were selected under the guidance of medial column classification. The patients' fractures were classified according to the Sanders classification: Type II, 35 cases; Type III, 33 cases; and Type IV, 23 cases. Among them, 53 patients had medial column displacement (shortened varus) and underwent open reduction and internal fixation with L-lateral incision of the calcaneus; 38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision. The calcaneus Böhler angle, Gissane angle, length, width, height, and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up. Foot function recovery was assessed by the Maryland foot scoring criteria.
All patients were followed for 5 to 14 mo, with an average of 10.5 ± 2.9 mo. The fractures of all patients healed, and the healing time was 10 to 19 wk, with an average of 10.8 ± 1.5 wk. One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection. The patient's fracture healed 5 mo after surgery. One patient developed a sural nerve injury, and the symptoms disappeared 3 mo after surgery. The patients were assessed according to the Maryland foot scoring system: Excellent in 77 cases, good in 10, and fair in 4. The excellent and good rate was 95.6%.
Medial column classification can effectively guide the surgical selection for intra-articular fractures of the calcaneus.
跟骨骨折的治疗方法有多种，包括保守治疗、传统手术治疗和微创手术。具体治疗方案的选择仍存在争议。切开复位内固定是目前临床上最常用的手术方法。采用跟骨外侧延长切口可获得良好的骨折复位效果；然而，许多研究报道术后切口并发症的发生率较高。虽然关节内跟骨骨折的分类方法众多，但一般认为Sanders提出的计算机断层扫描（CT）分类在跟骨骨折治疗方法的选择和预后评估中具有较高的应用价值。然而，该方法对手术切口和手术方案的选择没有明确的指导意义。
探讨内侧柱分类在关节内跟骨骨折治疗中的应用及临床疗效。
选取2017年7月至2018年7月收治的91例患者，其中男性60例，女性31例，年龄27～60岁。所有患者均为闭合性关节内跟骨骨折，在内侧柱分类指导下选择手术方式。患者骨折按Sanders分类：Ⅱ型35例，Ⅲ型33例，Ⅳ型23例。其中53例患者内侧柱移位（缩短内翻），采用跟骨L形外侧切口切开复位内固定；38例患者内侧柱无移位，采用跗骨窦切口切开复位内固定。术前、术后及末次随访时通过X线和三维CT评估跟骨Böhler角、Gissane角、关节面的长度、宽度、高度及台阶厚度。采用马里兰足部评分标准评估足部功能恢复情况。
所有患者随访5～14个月，平均10.5±2.9个月。所有患者骨折均愈合，愈合时间为10～19周，平均10.8±1.5周。1例患者术后1周出现伤口感染，积极清创并植入抗生素硫酸钙控制感染，术后5个月骨折愈合。1例患者出现腓肠神经损伤，术后3个月症状消失。采用马里兰足部评分系统对患者进行评估：优77例，良10例，可4例。优良率为95.6%。
内侧柱分类能有效指导关节内跟骨骨折的手术选择。
