Cao Yuan, Xu Xiangyu, Guo Yan, Cui Zengzhen, Zhao Yang, Gao Shan, Tian Yun, Lv Yang, Zhou Fang
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
Front Surg. 2022 Apr 4;9:854210. doi: 10.3389/fsurg.2022.854210. eCollection 2022.
Displaced intra-articular tongue-type fractures are often treated with surgical interventions, and there is a lack of consensus regarding the surgical approach. This retrospective cohort study aimed to compare percutaneous cannulated screw (PCS) fixation and plating with a minimally invasive longitudinal approach (MILA) after closed reduction for the treatment of tongue-type calcaneal fractures.
A total of 77 patients with intra-articular tongue-type calcaneal fractures between September 2015 and July 2019 were included in this study. They were randomly allocated into two groups: PCS fixation ( = 32) and MILA ( = 45). The outcome measures included demographic variables, operation time (OT), preoperative time (POT), hospital stay time (HST), blood loss, visual analog scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, postoperative complications, and imaging parameters. The patients were clinically examined at 1, 3, 6, and 12 months, with a final follow-up period of 27 months.
No significant differences were observed during the follow-up in calcaneal length, height, Gissane's and Böhler's angles, VAS scores, AOFAS hindfoot scores, or complication rates between the two groups. However, the postoperative VAS scores in the PCS group were significantly lower than those in the MILA group ( < 0.05). Furthermore, the OT, POT, and HST in the PCS group were significantly shorter than those in the MILA group ( < 0.05). Blood loss was lower in the PCS group than those in the other group ( = 0.044). However, postoperative calcaneal widening was significantly smaller in the MILA group than that in the PCS group ( < 0.001).
After closed reduction for the treatment of tongue-type calcaneal fractures, PCS fixation was superior to MILA in terms of OT, POT, HST, blood loss, pain, and degree of comfort. Meanwhile, MILA has the advantage of restoring the calcaneal width. Under the same rehabilitation program, the two approaches showed similar abilities in maintaining the closed reduction.
移位的关节内舌型跟骨骨折常采用手术干预治疗，而手术入路方面缺乏共识。本回顾性队列研究旨在比较闭合复位后经皮空心螺钉（PCS）固定和微创纵向入路（MILA）钢板固定治疗舌型跟骨骨折的效果。
本研究纳入了2015年9月至2019年7月期间共77例关节内舌型跟骨骨折患者。他们被随机分为两组：PCS固定组（n = 32）和MILA组（n = 45）。观察指标包括人口统计学变量、手术时间（OT）、术前时间（POT）、住院时间（HST）、失血量、视觉模拟评分（VAS）、美国足踝外科协会（AOFAS）后足评分、术后并发症及影像学参数。患者在术后1、3、6和12个月进行临床检查，最终随访期为27个月。
随访期间，两组在跟骨长度、高度、Gissane角和Böhler角、VAS评分、AOFAS后足评分或并发症发生率方面均未观察到显著差异。然而，PCS组术后VAS评分显著低于MILA组（P < 0.05）。此外，PCS组的OT、POT和HST显著短于MILA组（P < 0.05）。PCS组失血量低于另一组（P = 0.044）。然而，MILA组术后跟骨增宽明显小于PCS组（P < 0.001）。
闭合复位治疗舌型跟骨骨折后，PCS固定在OT、POT、HST、失血量、疼痛和舒适度方面优于MILA。同时，MILA在恢复跟骨宽度方面具有优势。在相同的康复方案下，两种方法在维持闭合复位方面显示出相似的能力。
