수술 후 컴퓨터 단층촬영을 이용한 관절 내 종골 골절의 정복과 임상 결과 간의 연관성 분석
Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography
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Purpose: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography andsimple X-ray in intra-articular calcaneal fractures. Materials and Methods: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgicaltreatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation ofpreoperative and postoperative Gissane angle, BÖhler angle, and calcaneal fracture width. Computed tomography scan was performedfor evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation ofthe postoperative clinical outcomes and radiologic findings based on the measurement. Results: The average postoperative AOFAS score and VAS score was 84.1±8.5 and 2.2±2.2. Subjective satisfaction was excellent in 15cases, good in 19 cases, and fair in seven cases. The average BÖhler angle was restored from 11.1° to 24.7° (p<0.05), Gissane angle waschanged from 121.0° to 119.0° (p>0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, BÖhler angle, and width, and there was no significant correlation between theclinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. Conclusion: The clinical outcome did not show correlation with BÖhler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.
Abstract
Purpose: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography andsimple X-ray in intra-articular calcaneal fractures. Materials and Methods: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgicaltreatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation ofpreoperative and postoperative Gissane angle, BÖhler angle, and calcaneal fracture width. Computed tomography scan was performedfor evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation ofthe postoperative clinical outcomes and radiologic findings based on the measurement. Results: The average postoperative AOFAS score and VAS score was 84.1±8.5 and 2.2±2.2. Subjective satisfaction was excellent in 15cases, good in 19 cases, and fair in seven cases. The average BÖhler angle was restored from 11.1° to 24.7° (p<0.05), Gissane angle waschanged from 121.0° to 119.0° (p>0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, BÖhler angle, and width, and there was no significant correlation between theclinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. Conclusion: The clinical outcome did not show correlation with BÖhler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.
참고문헌 (30)
- Cave EF, "Fracture of the os calcis--the problem in general", Clin Orthop Relat Res, 30, pp.64~66 (1963)
- Ebraheim NA, "Calcaneus fractures with subluxation of the posterior facet. A surgical indication", Clin Orthop Relat Res, (377), pp.210~216 (2000)
- Hildebrand KA, "Functional outcome measures after displaced intra-articular calcaneal fractures", J Bone Joint Surg Br, 78, pp.119~123 (1996)
- Sanders R, "Displaced intra-articular fractures of the calcaneus", J Bone Joint Surg Am, 82, pp.225~250 (2000)
- Magnan B, "External fixation for displaced intra-articular fractures of the calcaneum", J Bone Joint Surg Br, 88, pp.1474~1479 (2006)
- Kurozumi T, "Open reduction for intra-articular calcaneal fractures : evaluation using computed tomography", Foot Ankle Int, 24, pp.942~948 (2003)
- Parmar HV, "Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study", J Bone Joint Surg Br, 75, pp.932~937 (1993)
- 정형진, "광범위 외측 도달법을 이용한 관절내 종골 골절의 수술적 치료", 대한족부족관절학회지, 13(1), pp.60~67 (2009), 대한족부족관절학회
- Sanders R, "Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification", Clin Orthop Relat Res, (290), pp.87~95 (1993)
- Chapman MW, "Chapman’s orthopaedic surgery", pp.2966~2979 (2001), Lippincott Williams & Wilkins
- Essex-Lopresti P, "The mechanism, reduction technique, and results in fractures of the os calcis", Br J Surg, 39, pp.395~419 (1952)
- Carr JB, "Experimental intra-articular calcaneal fractures : anatomic basis for a new classification", Foot Ankle, 10, pp.81~87 (1989)
- Maxfield JE, "Experiences with the Palmer open reduction of fractures of the calcaneus", J Bone Joint Surg Am, 37, pp.99~106 (1955)
- Buckley RE, "Comparison of open versus closed reduction of intraarticular calcaneal fractures : a matched cohort in workmen", J Orthop Trauma, 6, pp.216~222 (1992)
- Giachino AA, "Intra-articular fractures of the calcaneus", J Bone Joint Surg Am, 71, pp.784~787 (1989)
- Kundel K, "Calcaneal fractures : operative versus nonoperative treatment", J Trauma, 41, pp.839~845 (1996)
- Song KS, "Preoperative and postoperative evaluation of intra-articular fractures of the calcaneus based on computed tomography scanning", J Orthop Trauma, 11, pp.435~440 (1997)
- Kim CW, "Comparison of the conservative and operative treatment of the intraarticular calcaneal fractures", J Korean Soc Fract, 12, pp.335~343 (1999)
- Kim KS, "Operative treatment of displaced intraarticular fractures of the calcaneus", J Korean Soc Fract, 11, pp.894~899 (1998)
- Roh JY, "Computed tomographic classification and operative treatment of intraarticular calcaneal fractures", J Korean Foot Surg Soc, 6, pp.149~155 (2002)
- Segal D, "Clinical application of computerized axial tomography (CAT) scanning of calcaneus fractures", Clin Orthop Relat Res, (199), pp.114~123 (1985)
- Dooley P, "Bilateral calcaneal fractures : operative versus nonoperative treatment", Foot Ankle Int, 25, pp.47~52 (2004)
- Buckley R, "Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures : a prospective, randomized, controlled multicenter trial", J Bone Joint Surg Am, 84, pp.1733~1744 (2002)
- Crosby LA, "Computerized tomography scanning of acute intra-articular fractures of the calcaneus. A new classification system", J Bone Joint Surg Am, 72, pp.852~859 (1990)
- Crosby LA, "Open reduction and internal fixation of type II intra-articular calcaneus fractures", Foot Ankle Int, 17, pp.253~258 (1996)
- Basile A, "Subjective results after surgical treatment for displaced intra-articular calcaneal fractures", J Foot Ankle Surg, 51, pp.182~186 (2012)
- Guyer BH, "Computed tomography of calcaneal fractures : anatomy, pathology, dosimetry, and clinical relevance", AJR Am J Roentgenol, 145, pp.911~919 (1985)
- Paley D, "Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors", J Bone Joint Surg Am, 75, pp.342~354 (1993)
- 김우식, "전위된 관절 내 종골 골절 환자의 수술 후 전산화 단층 촬영을 이용한 평가", 대한골절학회지, 17(3), pp.249~256 (2004), 대한골절학회
- Yu X, "Postoperative com plications after closed calcaneus fracture treated by open reduction and internal fixation: a review", J Int Med Res, 42, pp.17~25 (2014)