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Title: [Minimally invasive treatment of calcaneal fractures by subtalar arthroscopy with posterior approach].
Author: Dong F, Lu C, Zhu J, Li Y, Mi K.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Jan 15; 31(1):36-41. PubMed ID: 29798626.
Abstract:
OBJECTIVE: To evaluate the results of arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, IIB, and IIIAB. METHODS: Sixteen patients with unilateral calcaneal fracture were treated with arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint between June 2012 and June 2015. There were 13 males and 3 females with an average age of 37.8 years (range, 18-65 years). The injury causes included falling from height in 10 cases and traffic accident in 6 cases. Of 16 cases, 4 were classified as Essex-Lopresti tongue type, 5 as Sanders IIA, 4 as Sanders IIB, and 3 as Sanders IIIAB. The interval of injury and operation was 4-8 days (mean, 5.94 days). The Böhler angle, Gissane angle, and width of calcaneus were measured before and after operation. American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the ankle function at 12 months after operation. RESULTS: Primary healing of incision was obtained in all cases, and no complications of infection, necrosis, and osseous fascia compartment syndrome occurred. The patients were followed up 12-15 months (mean, 13.63 months). The X-ray films showed that fracture line disappeared at 6 months after operation; the patients had no tenderness or percussion pain, no breakage or loosening of internal fixation, no varus calcaneus tuberosity, no subtalar joint fusion, and no compression symptoms of peroneal tendons. Achilles tendon irritation occurred in 2 cases, and disappeared after removal of internal fixation; traumatic arthritis occurred in 2 cases, and was relieved after removal of internal fixation. The Böhler angle, Gissane angle, and calcaneal width were significantly improved at 3 days and 6 months after operation when compared with preoperative ones ( P<0.05). The loss of the above indexes was observed at 6 months, showing no significant difference between at 3 days and 6 months ( P>0.05). The AOFAS score results were excellent in 11 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. CONCLUSION: It has the advantages of little trauma, less complication, and good function recovery to use arthroscopically-assited closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, Sanders IIB, and Sanders IIIAB. 目的: 评价距下关节后侧入路关节镜辅助下闭合复位经皮空心螺钉内固定治疗 Essex-Lopresti 舌型及 Sanders ⅡA、ⅡB、ⅢAB 型跟骨骨折的临床效果。. 方法: 2012 年 6 月—2015 年 6 月，收治单侧跟骨骨折 16 例。男 13 例，女 3 例；年龄 18～65 岁，平均 37.8 岁。致伤原因：高处坠落伤 10 例，交通事故伤 6 例。Essex-Lopresti 舌型骨折 4 例，Sanders ⅡA 型 5 例、ⅡB 型 4 例、ⅢAB 型 3 例。受伤至手术时间 4～8 d，平均 5.94 d。均采用距下关节后外侧、后内侧入路关节镜辅助下闭合复位经皮空心螺钉内固定治疗。手术前后测量 Böhler 角、Gissane 角、跟骨宽度，术后 12 个月根据美国矫形足踝协会（AOFAS）踝-后足评分评价踝关节功能。. 结果: 术后切口Ⅰ期愈合，无坏死感染、骨筋膜室综合征等并发症发生。术后患者均获随访，随访时间 12～15 个月，平均 13.63 个月。术后 6 个月 X 线片示骨折线消失，局部无明显压痛及纵向叩击痛，无内固定物断裂及退出，跟骨外侧壁无明显突出，跟骨结节无明显内翻，足弓形态良好，无距下关节融合及腓骨肌腱压迫症状。术后 2 例发生跟腱激惹，取出内固定物后症状消失；2 例发生创伤性关节炎，其中 1 例症状明显者取出内固定物并行距下关节清理后症状缓解，另 1 例取钉时未予以关节清理，术后口服塞来昔布症状缓解。术后 3 d 及 6 个月 Böhler 角、Gissane 角、跟骨宽度均较术前明显改善（ P<0.05）；术后 6 个月各指标均较术后 3 d 轻度丢失，但差异无统计学意义（ P>0.05）。术后 12 个月根据 AOFAS 踝-后足评分评价踝关节功能，获优 11 例，良 3 例，中 2 例，优良率 87.5%。. 结论: 距下关节后侧入路关节镜辅助下闭合复位经皮空心螺钉固定可有效治疗 Essex-Lopresti 舌型及 Sanders ⅡA、ⅡB、ⅢAB 型跟骨骨折，创伤小、并发症少、功能恢复优良，发挥了微创手术的优势。.

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