Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China.
Orthop Surg. 2023 Mar;15(3):724-730. doi: 10.1111/os.13650. Epub 2023 Jan 4.
Accurate placement of the screws is challenging in percutaneous cannulated screw fixation of calcaneal fractures, and robot-assisted (RA) surgery enhances the accuracy. We investigated the outcome of percutaneous cannulated screw fixation of Sander's type II and III calcaneal fractures.
This retrospective study analyzed clinical data of 26 patients with fresh closed calcaneal fractures (28 fractures) who were admitted to our center from January 2022 to July 2022. All fractures were divided into the RA group and the open reduction and internal fixation (ORIF) group according to the surgeries performed. RA surgery was performed by closed reduction or open reduction combined with a tarsal sinus approach. Age, sex, operation time, preoperative waiting time, length of postoperative hospital stay, wound complications, and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) at 3 months postoperatively were compared. Preoperative and postoperative radiographic parameters (calcaneal length, width, height, Böhler angle, and fixation rate of the sustentaculum tali) were documented. The chi-square test, one-way analysis of variance, and Wilcoxon test were used for the comparison of categorical, normally distributed, and nonnormally distributed continuous variables, respectively.
The calcaneal width, height, and Böhler angle were significantly corrected postoperatively in both groups. The postoperative calcaneal lengths in both groups were also corrected. However, no significant difference was found. No significant differences in calcaneal length, width, height, and Böhler angle were observed between the two groups. The operation time (p < 0.001), preoperative waiting time (p < 0.001), and length of postoperative hospital stay (p = 0.003) in the RA surgery group were significantly shorter than those in the ORIF group. The fixation rate of the sustentaculum tali (p < 0.001) in the RA surgery group was significantly superior to that in the ORIF group. All wound complications occurred in the ORIF group. All fractures healed within 3 months. The AOFAS scores at 3 months postoperatively were not significantly different.
RA percutaneous screw fixation of the calcaneal fracture is a safe, effective, rapid, and minimally invasive surgical option for surgeons.
经皮空心螺钉固定跟骨骨折时，螺钉的准确置钉具有挑战性，机器人辅助（RA）手术可提高准确性。我们研究了 Sander Ⅱ型和Ⅲ型跟骨骨折经皮空心螺钉固定的结果。
本回顾性研究分析了 2022 年 1 月至 2022 年 7 月我院收治的 26 例新鲜闭合性跟骨骨折患者（28 例骨折）的临床资料。所有骨折均根据手术方式分为 RA 组和切开复位内固定（ORIF）组。RA 手术采用闭合复位或切开复位联合跗骨窦入路。比较两组患者的年龄、性别、手术时间、术前等待时间、术后住院时间、切口并发症和术后 3 个月美国矫形足踝协会踝关节后足评分（AOFAS）。记录术前和术后的影像学参数（跟骨长度、宽度、高度、Böhler 角和跟骨结节的固定率）。采用卡方检验、单因素方差分析和 Wilcoxon 检验分别比较分类变量、正态分布连续变量和非正态分布连续变量。
两组术后跟骨宽度、高度和 Böhler 角均明显矫正，两组术后跟骨长度也得到矫正，但差异无统计学意义。两组间跟骨长度、宽度、高度和 Böhler 角无明显差异。RA 手术组的手术时间（p<0.001）、术前等待时间（p<0.001）和术后住院时间（p=0.003）明显短于 ORIF 组。RA 手术组的跟骨结节固定率（p<0.001）明显优于 ORIF 组。所有切口并发症均发生在 ORIF 组，所有骨折均在 3 个月内愈合。术后 3 个月 AOFAS 评分无明显差异。
RA 经皮螺钉固定跟骨骨折是一种安全、有效、快速、微创的手术选择，可供外科医生选择。
