Abstract：
OBJECTIVE: To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images.
METHODS: In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary\'s angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires.
RESULTS: Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary\'s angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (- 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied.
CONCLUSIONS: Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.
METHODS: In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary\'s angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires.
RESULTS: Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary\'s angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (- 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied.
CONCLUSIONS: Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.
摘要：
目的：比较原发性关节固定术（PA）与切开复位内固定（ORIF）治疗移位的跟骨关节内骨折（DIACFs），基于临床结果以及从负重（WB）锥形束CT图像获得的2D和3D几何分析。
方法：在这项前瞻性研究中，包括40例手术治疗的跟骨骨折患者，由20名PA和20名ORIF患者组成。经过至少1年的随访，在PlanmedVerity锥束CT扫描仪上获取了左右后足和前足的负重锥束CT图像。自动二维和三维几何分析，即，（最小和平均）距骨关节间隙，跟骨螺距(CP),和Meary的角度（MA），为受伤和健康的脚获得。使用EQ5D和FFI问卷测量临床结果。
结果：总体而言，除年龄外,基线患者特征无差异(p<0.005).与PA（10.9°±4.5）相比，ORIF治疗后2D的跟骨间距（13.8°±5.6）更接近未受伤侧（18.1°±5.5）（p<0.001）。与ORIF组(15.5°±5.9)(p=0.046)相比,PA组(7.0°±5.8)术后2D的Meary/s角度更接近未受伤侧(8.7°±6.3)。在3D测量中，手术后两组的CP均显着降低（-4.09°±6.2）（p=0.001）。在3D中，MA整体或队列之间没有显着影响。ORIF和PA队列之间的临床结果没有显着差异。2D或3D的射线照相测量均未与所研究的任何临床结果相关。
结论：三维WBCT成像能够对复杂跟骨骨折患者进行自然负荷下的功能二维和三维分析。根据临床结果，PA和ORIF均显示可行的治疗选择.与几何结果的临床相关性仍有待确定。
方法：在这项前瞻性研究中，包括40例手术治疗的跟骨骨折患者，由20名PA和20名ORIF患者组成。经过至少1年的随访，在PlanmedVerity锥束CT扫描仪上获取了左右后足和前足的负重锥束CT图像。自动二维和三维几何分析，即，（最小和平均）距骨关节间隙，跟骨螺距(CP),和Meary的角度（MA），为受伤和健康的脚获得。使用EQ5D和FFI问卷测量临床结果。
结果：总体而言，除年龄外,基线患者特征无差异(p<0.005).与PA（10.9°±4.5）相比，ORIF治疗后2D的跟骨间距（13.8°±5.6）更接近未受伤侧（18.1°±5.5）（p<0.001）。与ORIF组(15.5°±5.9)(p=0.046)相比,PA组(7.0°±5.8)术后2D的Meary/s角度更接近未受伤侧(8.7°±6.3)。在3D测量中，手术后两组的CP均显着降低（-4.09°±6.2）（p=0.001）。在3D中，MA整体或队列之间没有显着影响。ORIF和PA队列之间的临床结果没有显着差异。2D或3D的射线照相测量均未与所研究的任何临床结果相关。
结论：三维WBCT成像能够对复杂跟骨骨折患者进行自然负荷下的功能二维和三维分析。根据临床结果，PA和ORIF均显示可行的治疗选择.与几何结果的临床相关性仍有待确定。
