Choi Young Jin, Bae Su-Young
Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
Heliyon. 2023 Jan 24;9(2):e13199. doi: 10.1016/j.heliyon.2023.e13199. eCollection 2023 Feb.
As minimal invasive techniques for depressed calcaneal fracture treatment have become more common, great progress has been achieved with various surgical methods. While these techniques are still currently utilized, new methods have been developed. This study aimed to report the radiologic and clinical outcomes of depressed calcaneal fracture treatment with the "push-out molding" technique and to propose its clinical utility.
From March 2009 to October 2020, a retrospective study was conducted with 52 patients, who received the "push-out molding" technique to treat depressed intra-articular calcaneal fractures (Sanders type II, III, IV). Exclusion criteria were as follows: patients with bilateral calcaneal fractures, open fractures, and a follow-up period <12 months. Radiologic parameters were assessed at following periods: preoperative, postoperative, 3-month follow-up, and last follow-up. Limitation of range of motion (ROM), subjective satisfaction, and complications were assessed at the last follow-up period. Repeated measures ANOVA was used to analyze values at preoperative, postoperative, 3-month, and last follow-up periods.
Significant differences in the talo-calcaneal angle (p < 0.001), Böhler's angle (p=<0.001), Gissane's angle (p = 0.023), distance from the lower cortical border of calcaneus to the anterior (p=<0.001) and posterior (p=<0.001) points of posterior articular surface, calcaneal length (p = 0.019), and talo-calcaneal height (p=<0.001). Postoperatively, the posterior articular surface was well maintained, while 21.2% retained a ROM limitation by 20° or higher. Subjective satisfaction was as follows: excellent (42.3%), good (48.1%), fair (9.6%), and poor (0%).
The "push-out molding" is a simple technique with the advantage of not requiring much force to treat depressed calcaneal fractures. It can be used as a beneficial surgical technique with minimal damage to the soft tissue, owing to the reduction from the depressed interior part and less severe ROM limitation.
随着用于治疗跟骨骨折的微创技术日益普及，各种手术方法取得了巨大进展。虽然这些技术目前仍在使用，但也开发出了新的方法。本研究旨在报告采用“推顶成型”技术治疗跟骨骨折的影像学和临床结果，并探讨其临床应用价值。
2009年3月至2020年10月，对52例接受“推顶成型”技术治疗关节内跟骨骨折（Sanders II型、III型、IV型）的患者进行了回顾性研究。排除标准如下：双侧跟骨骨折患者、开放性骨折患者以及随访时间<12个月的患者。在术前、术后、3个月随访及末次随访时评估影像学参数。在末次随访时评估活动范围（ROM）受限情况、主观满意度及并发症。采用重复测量方差分析对术前、术后、3个月及末次随访时的值进行分析。
跟骨结节关节角（p<0.001）、Böhler角（p =<0.001）、Gissane角（p = 0.023）、跟骨下皮质边界至后关节面前方（p =<0.001）和后方（p =<0.001）点的距离、跟骨长度（p = 0.019）及跟骨结节高度（p =<0.001）存在显著差异。术后，后关节面维持良好，21.2%的患者活动范围受限20°或以上。主观满意度如下：优（42.3%）、良（48.1%）、中（9.6%）、差（0%）。
“推顶成型”技术操作简单，治疗跟骨骨折时无需施加太大力量。由于从凹陷内部进行复位且活动范围受限程度较轻，该技术对软组织损伤极小，可作为一种有益的手术技术。
