PDF(Pubmed)
Abstract：
Background: The treatment of displaced intra-articular calcaneal fractures (DIACF) is debated. This study compares open reduction and internal fixation (ORIF) with minimally invasive osteosynthesis (MIOS). Methods: We conducted a retrospective study on 70 patients with DIACF treated between January 2018 and September 2022, divided into ORIF (n = 50) and MIOS (n = 20) groups. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). Radiographic outcomes, complication rates, and reintervention rates were evaluated. A chi-square analysis examined the correlation between Sanders classification and treatment choice. Results: The chi-square analysis indicated no significant correlation between the complexity of the fracture and the type of treatment chosen (χ2 = 0.175, p = 0.916). Additionally, the Cochran-Armitage test for trend showed no significant trend in the choice of treatment based on fracture complexity (statistic = 0.048, p = 0.826). A Kaplan-Meier analysis showed a longer time to reintervention for MIOS (p = 0.029). Complication rates were similar, with specific complications varying between groups. Quality-of-life outcomes were comparable. Conclusions: ORIF is preferable for high-demand patients due to better anatomical outcomes, while MIOS suits high-risk patients by reducing reinterventions and complications. Further randomized trials are needed to confirm these findings.
摘要：
背景：移位的跟骨关节内骨折（DIACF）的治疗存在争议。这项研究比较了切开复位内固定（ORIF）与微创骨固定（MIOS）。方法：我们对2018年1月至2022年9月治疗的70例DIACF患者进行了回顾性研究，分为ORIF组（n=50）和MIOS组（n=20）。使用马里兰足评分（MFS）和Creighton-Nebraska健康基金会评估量表（CNHFAS）评估功能结果。射线照相结果，并发症发生率,并评估了再干预率。卡方分析检查了Sanders分类与治疗选择之间的相关性。结果：卡方分析显示骨折的复杂性与所选择的治疗类型之间没有显着相关性（χ2=0.175，p=0.916）。此外,趋势的Cochran-Armitage检验显示，基于骨折复杂性的治疗选择没有显着趋势（统计量=0.048，p=0.826）。Kaplan-Meier分析显示，MIOS的再干预时间更长（p=0.029）。并发症发生率相似，具体的并发症在组间有所不同。生活质量结果具有可比性。结论：由于更好的解剖结果，ORIF对于高需求患者是优选的，而MIOS通过减少再干预和并发症来适合高风险患者。需要进一步的随机试验来证实这些发现。
