Jiang Guiyong, Li Jie, Zhang Xiaolong, Shu Shan, Ma Yunfei, Zhang Ping, Wang Gang, Liao Hua, Hu Jijie
Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Orthopaedics, Southern Medical University Zengcheng Branch of Nanfang Hospital, Guangzhou, People's Republic of China.
Orthop Surg. 2023 Oct;15(10):2540-2548. doi: 10.1111/os.13828. Epub 2023 Aug 1.
Minimally invasive reduction and fixation of intra-articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra-articular calcaneal fractures, and propose the indications of our protocol.
In this retrospective study, a series of 34 consecutive closed and displaced intra-articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X-ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed-rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired-Samples t-test.
Thirty-two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow-up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor.
For intra-articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub-talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity.
关节内跟骨骨折的微创复位与固定给骨科医生带来了巨大挑战。本研究的目的是报告技术要点，评估临时肢体重建系统（LRS）外固定器辅助下的关节内跟骨骨折微创复位及内固定的疗效，并提出我们方案的适应证。
在这项回顾性研究中，2016年6月至2018年4月期间，采用该技术连续治疗了34例涉及关节面的闭合性移位关节内跟骨骨折。手术前后进行X线和计算机断层扫描（CT）以测量Bohler角、跟骨的长度、高度和宽度以及后足的机械轴。记录术后并发症。使用美国矫形足踝协会（AOFAS）后足-踝关节评分系统综合评估影像学和临床结果。在检验数据的正态性后，使用Wilcoxon符号秩检验比较Bohler角和跟骨长度。使用配对样本t检验比较跟骨的高度、宽度以及后足的机械轴。
32例骨折平均随访20.66个月（12至32个月）。所有骨折均实现稳定复位和骨性愈合。通过跗骨窦切口直视下对关节面进行复位和固定。随访期间未发现内固定失败或复位丢失。无软组织并发症。Bohler角、跟骨的长度、高度和宽度以及后足的机械轴均有显著改善。AOFAS评分平均为84.12分；7例为优，20例为良，4例为中，1例为差。
对于关节内跟骨骨折，临时LRS外固定器辅助下的微创手术可重建跟骨形态和距下关节面。这种并发症有限的简单手术方式可能有助于治疗大多数II型和III型跟骨骨折，但跟骨结节粉碎性骨折除外。
