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Title: [Effectiveness of vertical compression of locking plate combined with hollow screws in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures].
Author: Zhang Y, Zhao Y, Du R, Liu Y, Sun G.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Apr 15; 38(4):432-437. PubMed ID: 38632062.
Abstract:
OBJECTIVE: To probe into the effectiveness of vertical compression of locking plate combined with hollow screws in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. METHODS: The clinical data of 128 patients with Sanders type Ⅱ and Ⅲ calcaneal fractures who were admitted between March 2019 and April 2022 and met the selection criteria were retrospectively analyzed. Among them, 65 patients were treated with locking plate combined with hollow screw vertical compression (study group), and 63 patients were treated with simple locking plate (control group). There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, fracture side and Sanders classification, cause of injury, time from injury to operation. The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded and compared between the two groups. Before operation and at 12 months after operation, the American Orthopaedic Foot and Ankle Association (AOFAS) score (including total score, pain score, functional score, and alignment score) was used to evaluate the recovery of foot function, and imaging indicators such as calcaneal width, calcaneal height, calcaneal length, Böhler angle, and Gissane angle were measured on X-ray films. RESULTS: All patients were followed up 12 months after operation. There was no significant difference in operation time, intraoperative blood loss, hospital stay, and fracture healing time between the two groups ( P>0.05). Poor wound healing occurred in 1 case in the study group and 2 cases in the control group. At 12 months after operation, there was no significant difference between the two groups in the pre- and post-operative difference of calcaneal length, calcaneal height, Gissane angle, and Böhler angle ( P>0.05). However, the pre- and post-operative difference in calcaneal width in the study group was significantly higher than that in the control group ( P<0.05). The pre- and post-operative difference of AOFAS total score in the study group was significantly higher than that in the control group ( P<0.05), and further analysis showed that the pre- and post-operative difference of pain and function scores in the study group were significantly higher than those in the control group ( P<0.05), while there was no significant difference in the pre- and post-operative difference of force score between the two groups ( P>0.05). CONCLUSION: Compared with simple locking plate treatment, the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures with vertical compression of locking plate combined with hollow screws can more effectively improve the width of the subtalar calcaneal articular surface, avoid peroneal longus and brevis impingement, reduce pain, and increase the range of motion of the subtalar joint, and the effectiveness is better. 目的: 探讨锁定钢板联合空心螺钉垂直加压治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床效果。. 方法: 回顾分析2019年3月—2022年4月收治且符合选择标准的128例Sanders Ⅱ、Ⅲ型跟骨骨折患者临床资料。其中65例采用锁定钢板联合空心螺钉垂直加压治疗（研究组），63例采用单纯锁定钢板治疗（对照组）。两组患者性别、年龄、骨折侧别及Sanders分型、致伤原因、受伤至手术时间等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间；术前及术后12个月采用美国矫形足踝协会（AOFAS）评分（包括总分、疼痛评分、功能评分、力线评分）评价患者足部功能恢复情况，并于X线片上测量跟骨宽度、跟骨高度、跟骨长度、Böhler角、Gissane角等影像学指标。. 结果: 所有患者均随访至术后12个月。两组患者手术时间、术中出血量、住院时间和骨折愈合时间比较差异均无统计学意义（ P>0.05）。研究组和对照组分别出现1例和2例切口愈合不良。术后12个月，两组间跟骨长度、跟骨高度、Gissane角及Böhler角手术前后差值比较，差异无统计学意义（ P>0.05）；但研究组跟骨宽度手术前后差值显著高于对照组（ P<0.05）。研究组患者AOFAS评分总分手术前后差值显著高于对照组，差异有统计学意义（ P<0.05）；进一步分析示，研究组疼痛和功能评分手术前后差值明显高于对照组（ P<0.05），而力线评分手术前后差值两组间差异无统计学意义（ P>0.05）。. 结论: 与单纯锁定钢板固定相比，锁定钢板联合空心螺钉垂直加压治疗Sanders Ⅱ、Ⅲ型跟骨骨折，可以更加有效地改善跟骨距下关节面宽度，避免腓骨长短肌撞击，减轻患者疼痛，增加距下关节活动度，临床效果较好。.

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