von Deimling Christian, Graf David Alexander, Hasler Julian, Brunner Samuel, Helmy Naeder, Tondelli Timo
Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, 4500, Switzerland.
Eur J Orthop Surg Traumatol. 2025 Jul 20;35(1):311. doi: 10.1007/s00590-025-04421-2.
There is growing but so far inconclusive evidence about the value of three-dimensional (3D) fluoroscopy in calcaneal fracture care. The aim of this study was to retrospectively review our own cohort of calcaneus fractures before and after the implementation of 3D fluoroscopy and compare their outcome in terms of quality of reduction and amendments made based on the additional information gained by 3D imaging.
Between March 2012 and October 2022, we operated on 28 calcaneal fractures in 25 patients of whom eight were treated with the aid of 3D fluoroscopy (= hybrid group). In all cases, a sinus tarsi approach (STA) and an angular stable plate were used. Intra- and postoperative scans were analyzed based on the Delphi Consensus criteria evaluating quality of reduction and radiographic outcome. Statistical analyses were performed to check for statistical significance and inter-rater reliability.
We found no difference between the two groups (one group treated with conventional fluoroscopy and the other with 3D fluoroscopy) in terms of quality of reduction and radiographic outcome. Nevertheless, in more than half of our patients in the hybrid group, amendments were made based on the information gained through 3D fluoroscopy. Median radiation dose and surgical time was prolonged in the hybrid group but not leading to an increased infection rate.
We found satisfactory outcomes in osteosynthesis of calcaneus fractures using the STA, regardless of whether conventional or 3D fluoroscopy was used intraoperatively. However, no significant improvement due to usage of intraoperative 3D fluoroscopy imaging in terms of restoration of the anatomy and quality of reduction could be found. Nevertheless, 3D fluoroscopy helps to avoid revision surgeries due to intra-articular placed screws and does not seem to lead to more cases of infection despite slightly prolonged operation times.
关于三维（3D）荧光透视在跟骨骨折治疗中的价值，证据越来越多，但迄今为止尚无定论。本研究的目的是回顾性分析我们自己的跟骨骨折患者队列在实施3D荧光透视前后的情况，并根据复位质量以及基于3D成像获得的额外信息所做的修正，比较其治疗结果。
2012年3月至2022年10月期间，我们对25例患者的28例跟骨骨折进行了手术，其中8例在3D荧光透视辅助下治疗（=混合组）。所有病例均采用跗骨窦入路（STA）和角稳定钢板。根据Delphi共识标准对术中和术后扫描进行分析，评估复位质量和影像学结果。进行统计分析以检验统计学意义和评分者间信度。
在复位质量和影像学结果方面，我们发现两组（一组采用传统荧光透视治疗，另一组采用3D荧光透视治疗）之间没有差异。然而，在混合组中，超过一半的患者根据通过3D荧光透视获得的信息进行了修正。混合组的中位辐射剂量和手术时间延长，但未导致感染率增加。
无论术中使用传统荧光透视还是3D荧光透视，我们发现使用STA治疗跟骨骨折的骨接合术效果令人满意。然而，在解剖结构恢复和复位质量方面，未发现术中使用3D荧光透视成像有显著改善。尽管如此，3D荧光透视有助于避免因关节内螺钉置入导致的翻修手术，并且尽管手术时间略有延长，但似乎不会导致更多感染病例。
