Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy/Istanbul, Turkey.
Department of Orthopedics and Traumatology, Ümraniye Education and Research Hospital, Adem Yavuz St. Number 1, 34764, Ümraniye/Istanbul, Turkey.
Int Orthop. 2021 Mar;45(3):731-741. doi: 10.1007/s00264-021-04944-3. Epub 2021 Jan 30.
Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs).
Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes.
VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively).
Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term results.
尽管现代手术技术和文献中有大量研究，但对于骨科医生来说，跟骨骨折的最佳治疗方法仍然是一个谜。本研究的目的是比较解剖跟骨钢板（ACP）固定与交叉 Schanz 钉（CSP）固定治疗 Sanders Ⅱ型和Ⅲ型关节内移位跟骨骨折（DICF）的临床和影像学结果。
回顾性分析 2009 年 1 月至 2013 年 2 月期间接受 DCIF 手术的 65 例患者（49 例男性，16 例女性）。根据手术技术将患者分为 ACP 组和 CSP 组。比较两组患者的一般特征、损伤机制、手术时间、透视曝光率、并发症、完全负重时间、功能和影像学结果。
两组患者的视觉模拟评分（VAS）休息评分无显著差异，而 CSP 组的 VAS 活动评分显著更高（p=0.001 和 p=0.645）。跟骨骨折功能指数（FFI）评分显著更低，而 Maryland 足部评分（MFS）和美国矫形足踝协会-后足评分（AOFAS）评分显著更高（p=0.047、p=0.016 和 p<0.001）。尽管术前和术后第 1 天的 Böhler 角和 Gissane 角无差异，但 ACP 组在术后最后一次随访时均显著更高（p<0.001 和 p<0.001）。
与解剖跟骨钢板相比，交叉 Schanz 钉固定虽然可以缩短手术时间，但透视曝光率增加和功能及影像学结果较差是交叉 Schanz 钉固定的不利因素。解剖跟骨钢板仍然是一种更好的技术，可以保持对线，抬高关节内移位的节段，获得良好至优秀的中期结果。
