Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, China.
BMC Musculoskelet Disord. 2024 Oct 25;25(1):849. doi: 10.1186/s12891-024-07960-7.
The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device.
The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45-72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy.
52 patients were followed up for 23.7 ± 3.2 months (range: 20-28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P<0.05). There was no difference between calcaneal radiographic parameters at 6,12 months and the last follow-up compared with 3 days after surgery without significant loss in overall morphology (P>0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P<0.05).
Preoperative ultrasonic locating LCB of the sural nerve and arthroscopic percutaneous minimally invasive screw fixation of Sanders II and III calcaneal fractures with the assistance of calcaneal-talar joint distraction have good short-term efficacy and clinical feasibility in diabetic patients.
对于伴有软组织并发症的糖尿病患者的跟骨移位骨折，手术治疗和管理仍然存在争议。我们旨在评估在跗骨下关节镜辅助下，术前使用肌骨超声定位外踝后皮神经的跟骨外侧支（LCB）和跟距关节牵开器，对 Sanders II 和 III 型跟骨骨折患者行经皮微创螺钉固定的短期疗效。
对 2016 年 3 月至 2020 年 8 月确诊为 Sanders II 或 III 型跟骨骨折的 52 例糖尿病患者的临床资料进行随访分析。其中 II 型 23 例，III 型 29 例；男 34 例，女 18 例；年龄 45-72 岁，平均 61.7±14.5 岁。常规行肌骨超声检查定位外踝后皮神经的 LCB。术中行关节镜下经皮撬拨复位螺钉固定，辅助内侧跟距关节牵开。术后 3d、6 个月、12 个月及末次随访时定期观察切口愈合情况、局部皮肤麻木等情况，并拍摄跟骨侧位和轴位 X 线片，测量跟骨长度、宽度、高度、Böhler 角、Gissane 角。采用视觉模拟疼痛评分（VAS）、美国矫形足踝协会（AOFAS）评分和 Maryland 评分评估疗效。
52 例患者获得 23.7±3.2 个月（20-28 个月）的随访，无切口相关并发症。术后跟骨影像学参数（长度、宽度、高度、Böhler/Gissane 角）均得到改善，差异均有统计学意义（P<0.05）。术后 6 个月、12 个月及末次随访与术后 3d 比较，跟骨影像学参数差异无统计学意义，总体形态无明显丢失（P>0.05）。术后 VAS、AOFAS 评分和 Maryland 评分均较术前明显改善（P<0.05）。
术前超声定位外踝后皮神经的 LCB，在跗骨下关节镜辅助下，采用跟距关节牵开器辅助行经皮微创螺钉固定 Sanders II 和 III 型跟骨骨折，在糖尿病患者中具有良好的短期疗效和临床可行性。
