Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Acta Orthop Traumatol Turc. 2021 May;55(3):258-264. doi: 10.5152/j.aott.2021.20003.
The aim of this study was to compare clinical and radiological outcomes of screw fixation alone versus screw with small locking plate fixation techniques in the management of intra-articular calcaneal fractures by minimal invasive surgery.
A total of 42 patients treated with minimally invasive surgery because of an intra-articular calcaneal fracture were retrospectively reviewed and included in the study. The patient were then divided into two groups based on the implemented surgical technique: Group A, 20 patients (16 male, 4 female; mean age = 43.41 ± 15.50) receiving screw fixation alone and group B, 22 patients (17 male, 5 female; mean age = 43.38 ± 14.00) receiving screw with small locking plate fixation. The radiographic assessment included Bohler's, Gissane, joint line parallel, and calcaneal varus angles at immediate post-operative and 2-year follow up period through the calcaneal axial and lateral foot radiographs.
There was a significant increase in joint line parallel angle from post-operative period to 2-year follow up in Group A compared to Group B, mean (SD) 3.27 (2.15) degrees versus (vs) 0.44 (3.00) degrees, P = 0.025. No statistical significant difference of the immediate, 2-year post-operative period and the change in Bohler's-Gissane angle, calcaneal varus, and FAAM of ADL between groups were observed, P > 0.05. For time-point comparisons in each group, there was a significant loss of calcaneal varus and increase in joint line parallel angle from post-operative period to 2-year follow up in Group A, from mean (SD) 1.82 (11.22) to 4.41 (9.73) degrees and 4.09 (5.32) to 7.36 (5.24) degrees, P = 0.047 and <0.0001, respectively. Group A had statistical significant less complications as zero vs 5, P = 0.049.
The screw fixation alone seems to provide inferior stability of posterior facet fixation and calcaneal varus reduction with lower complication rates compared to screw with small-locking plate fixation.
Level III, Therapeutic Study.
本研究旨在比较微创治疗关节内跟骨骨折时单纯螺钉固定与小锁定钢板螺钉固定技术的临床和影像学结果。
回顾性分析 42 例因关节内跟骨骨折行微创治疗的患者，并纳入本研究。然后根据实施的手术技术将患者分为两组：A 组 20 例（16 名男性，4 名女性；平均年龄=43.41±15.50 岁）接受单纯螺钉固定，B 组 22 例（17 名男性，5 名女性；平均年龄=43.38±14.00 岁）接受小锁定钢板螺钉固定。影像学评估包括术后即刻和 2 年随访时的 Bohler 角、Gissane 角、关节线平行角和跟骨内翻角，通过跟骨轴向和侧位足部 X 线片进行。
与 B 组相比，A 组术后即刻至 2 年随访时关节线平行角显著增加，平均（标准差）为 3.27（2.15）° vs 0.44（3.00）°，P=0.025。两组间即刻、2 年随访时 Bohler-Gissane 角、跟骨内翻、FAAM-ADL 的变化无统计学差异，P＞0.05。在每组的时间点比较中，A 组术后即刻至 2 年随访时跟骨内翻明显减少，关节线平行角显著增加，分别从平均（标准差）1.82（11.22）°至 4.41（9.73）°和 4.09（5.32）°至 7.36（5.24）°，P=0.047 和＜0.0001。A 组并发症发生率明显低于 B 组（零 vs 5，P=0.049）。
与小锁定钢板螺钉固定相比，单纯螺钉固定似乎提供了较差的后关节面固定稳定性和跟骨内翻矫正，并发症发生率较低。
III 级，治疗性研究。
