Feng S M, Zhao J J, Ma C, Xu W
Department of Orthopedics,Xuzhou Central Hospital,Xuzhou 221009,China.
Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Zhonghua Wai Ke Za Zhi. 2022 Jun 1;60(6):546-551. doi: 10.3760/cma.j.cn112139-20211008-00475.
To investigate the surgical technology and clinical efficacy of using the all-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ. The clinical data of 33 patients (33 feet) with intra-articular displaced calcaneal fractures treated by modified all-inside arthroscopic from March 2017 to March 2019 at Department of Orthopedics,Xuzhou Central Hospital were retrospectively analyzed.There were 19 male patients,and 14 female patients,aged (32.6±11.3) years(range:20 to 55 years). According to the Sanders classification,there were 12 cases of type Ⅱ and 21 cases of type Ⅲ. The duration from injury to surgery was (101.2±32.1) hours(range:6 to 140 hours).The preoperative visual analogue scale (VAS) was 6.4±2.9 (range: 4 to 8); The preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the SF-36 score was 63.3±11.8 (range:50 to 75) and 94.8±9.1 (range:70 to 105) respectively.All the patients were managed with the all-side subtalar arthroscopy through three portals combined with rafting screws technique.The incision healing,reduction of fracture,and fracture healing were recorded.The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were used to assess the pain and functional outcomes.Repeated-measurement was used to compare the scores before and after surgery. The time of operation was (69.7±10.4) minutes (range:40 to 110 minutes). All patients did not undergo bone grafting.The incision healed in one stage without complications of skin sensory and peroneal tendon injury.All patients were followed up for 24 months.At the last follow-up,all the patients were satisfied with the hindfoot alignment,function,and hindfoot appearance.Postoperative calcaneal imaging indicators (calcaneal length,calcaneal width,calcaneal height,Bohler angle and Gissane angle) were significantly improved compared with those before surgery (<0.01).There was no statistically significant difference in the imaging indexes of calcaneus at 1 day,1 year and 2 years after surgery,indicating no loss of fracture reduction (all >0.05).The VAS,AOFAS ankle-hindfoot scale,and SF-36 score were 1.5±0.4 (range: 0 to 2),94.0±6.5 (range:90 to 100),and 119.1±7.2 (range:105 to 130),respectively,which were better than those before surgery (all >0.05).According to the AOFAS scoring system,27 cases were excellent,4 cases were good, 2 cases were fair,and the excellent and good rate was 94.0%. All-inside subtalar arthroscopy through three portals combined with rafting screws technique for the treatment of the calcaneal fractures of Sanders Ⅱ and Ⅲ provides precise reduction,reliable fixation,satisfactory function and limited complications,which is an alternative method.
探讨经三通道全关节镜下距下关节镜联合筏式螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折的手术技术及临床疗效。回顾性分析2017年3月至2019年3月徐州中心医院骨科采用改良全关节镜下距下关节镜治疗的33例（33足）关节内移位跟骨骨折患者的临床资料。男性19例，女性14例，年龄（32.6±11.3）岁（范围：20～55岁）。按Sanders分型，Ⅱ型12例，Ⅲ型21例。受伤至手术时间为（101.2±32.1）小时（范围：6～140小时）。术前视觉模拟评分（VAS）为6.4±2.9（范围：4～8）；术前美国矫形足踝协会（AOFAS）踝-后足评分及SF-36评分为63.3±11.8（范围：50～75）和94.8±9.1（范围：70～105）。所有患者均采用经三通道全关节镜下距下关节镜联合筏式螺钉技术治疗。记录切口愈合情况、骨折复位情况及骨折愈合情况。采用VAS、AOFAS踝-后足评分及SF-36评分评估疼痛及功能结局。采用重复测量比较手术前后评分。手术时间为（69.7±10.4）分钟（范围：40～110分钟）。所有患者均未行植骨。切口一期愈合，无皮肤感觉及腓骨肌腱损伤并发症。所有患者均随访24个月。末次随访时，所有患者对后足对线、功能及后足外观均满意。术后跟骨影像学指标（跟骨长度、跟骨宽度、跟骨高度、Bohler角及Gissane角）较术前明显改善（<0.01）。术后1天、1年及2年跟骨影像学指标差异无统计学意义，表明骨折复位无丢失（均>0.05）。VAS、AOFAS踝-后足评分及SF-36评分分别为1.5±0.4（范围：0～2）、94.0±6.5（范围：90～100）及119.1±7.2（范围：105～130），均优于术前（均>0.05）。根据AOFAS评分系统，优27例，良4例，可2例，优良率为94.0%。经三通道全关节镜下距下关节镜联合筏式螺钉技术治疗SandersⅡ、Ⅲ型跟骨骨折可提供精确复位、可靠固定、满意功能及有限并发症，是一种可供选择的方法。
