Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China.
BMC Musculoskelet Disord. 2022 Jun 10;23(1):562. doi: 10.1186/s12891-022-05515-2.
The aim of this retrospective monocentric study was to investigate the clinical efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures (DIACFs).
The medical records of calcaneal fractures patients who were admitted to our department from January 2018 to January 2020 were retrospectively reviewed, and those meeting the inclusion criteria were fnally included for analysis. All patients were treated with percutaneous reduction and screw fixation, and no patients received bone grafting. The radiologic parameters evaluated included the BÖhler angle and the calcaneal height. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, Maryland Foot Score (MFS), and visual analog scale (VAS) score were determined.
Thirty-eight patients with Sanders Type-II and Type-III DIACFs were finally included, including 30 males and 8 females aged 21 to 61 years [(42.6 ± 9.6) years]. According to the Essex-Lopresti classification, 27 of the fractures were the tongue type, and 11 were the joint compression type. According to the Sanders classification, 27 of the fractures were type II, and 11 were type III. Immediately postoperatively, the calcaneal height had recovered to 39.8 ± 2.1 mm, the BÖhler angle had recovered from 4.2° ± 13.6° preoperatively to 27.2° ± 3.4° (P = 0.000). All patients were followed up for 18-42 months [(25.2 ± 9.5) months]. All fractures healed. No differences were found in the outcome measures six-months postoperatively (BÖhler angle, p = 0.24; calcaneal height, p = 0.82) or at final follow-up (BÖhler angle, p = 0.33; calcaneal height, p = 0.28) compared to the immediately postoperative values. At the final follow-up, the AOFAS score was 91.7 ± 7.4 points, with an excellent and good rate of 92.1%; the MFS was 90.3 ± 7.8 points, with an excellent and good rate of 92.1%; and the VAS score was 2.2 ± 1.5 points. None of the patients had incision complications, and one patient developed traumatic arthritis.
Percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III DIACFs can achieve good recovery and maintenance of the BÖhler angle and calcaneal height. Moreover, it has the advantage of a low complication rate.
本回顾性单中心研究旨在探讨 Sanders II 型和 III 型关节内移位跟骨骨折（DIACFs）患者经皮复位螺钉固定而不植骨的临床疗效。
回顾性分析 2018 年 1 月至 2020 年 1 月我院收治的跟骨骨折患者的病历资料，符合纳入标准的患者纳入分析。所有患者均采用经皮复位螺钉固定治疗，均未行植骨。评估的影像学参数包括 Böhler 角和跟骨高度。此外，还测定了美国矫形足踝协会（AOFAS）后足评分、Maryland 足部评分（MFS）和视觉模拟评分（VAS）。
最终纳入 38 例 Sanders II 型和 III 型 DIACFs 患者，男 30 例，女 8 例；年龄 21-61 岁，平均（42.6±9.6）岁。根据 Essex-Lopresti 分型，27 例为舌型，11 例为关节压缩型。根据 Sanders 分型，27 例为 II 型，11 例为 III 型。术后即刻，跟骨高度恢复至 39.8±2.1mm，Böhler 角从术前的 4.2°±13.6°恢复至 27.2°±3.4°（P=0.000）。所有患者均获得 18-42 个月随访（25.2±9.5 个月）。所有骨折均愈合。术后 6 个月（Böhler 角，P=0.24；跟骨高度，P=0.82）和末次随访（Böhler 角，P=0.33；跟骨高度，P=0.28）与术后即刻相比，各指标差异均无统计学意义。末次随访时，AOFAS 评分为 91.7±7.4 分，优良率为 92.1%；MFS 评分为 90.3±7.8 分，优良率为 92.1%；VAS 评分为 2.2±1.5 分。无切口并发症，1 例发生创伤性关节炎。
Sanders II 型和 III 型 DIACFs 患者经皮复位螺钉固定而不植骨可获得良好的 Böhler 角和跟骨高度恢复，且并发症发生率低。
