Clinical Guiding Significance Of Classification Of Three-dimensional Reconstruction Imaging With Spiral CT In The Operative Treatment Of Calcaneal Fractures

Objective:To recommend the classification of calcaneal fractures based on three-dimensional reconstruction imaging with spiral CT and to evaluate the its clinical guiding significance in the operative treatment of calcaneal fracture.Method:From October 2005 to October 2008, 92 cases with 132 calcaneal fracture were reviewed in our hospital ,which included 96 cases of 76 males and 36 cases of 16 females with an average age of 38.2 years(range,16 to 73 years). The mechanisms of injury were falling down in 101 cases ,traffic accident in 16 cases and other cause in 15 cases. To attempts to classify 132 cases of calcaneal fractures using spiral CT with multiplanar reconstruction in our hospital. The calcaneal fractures were divided into 8 types. There were 9 cases in typeⅠA,18 typeⅠB,19typeⅠC,17 typeⅡA,20 typeⅡB,18typeⅡC,14 typeⅡD,17typeⅢin our group. Various treatment approach were chose according to this classification system,90 of them were treated with open reduction and 42 with poking reduction. 4 cases in typeⅠA,6typeⅠB,5 typeⅠC,6 typeⅡA, 7 typeⅡB,4 typeⅡC,5 typeⅡD,5 typeⅢwere treated with poking reduction ,and 5 typeⅠA,12 typeⅠB,14 typeⅠC,11 typeⅡA,13 typeⅡB,14 typeⅡC,9 typeⅡD,12 typeⅢwere treated with open reduction. The whole procedure was done under monitoring of"C"-arm fluoroscopy for safety and accuracy.Results:: 132cases were followed up for an average of 18.4 months (range,12 to 32 months). The Maryland foot assessment score system was used for evaluation. Total excellent and good rate in operative group was 73.58%, it was 77.78% in type IA, 77.78% in type IB, 70.58% in type IC, 70.59% in typeⅡA, 60.00% in typeⅡB, 66.70% in typeⅡC, 57.14% in typeⅡD, 58.82% in typeⅢ. In the poking reduction group, the preoperative B?hler's angle was 8.50±8.28°on average, and postoperative 29.90±8.11°on average . The preoperative Gissane's angle was 90.70±14.07°on average; and postoperative 117.80±12.2°on average . In the open reduction group, the preoperative B?hler's angle was 7.50±7.92°on average, and postoperative 30.18±8.37°on average . The preoperative Gissane's angle was 84.64±13.07°on average; and postoperative 120.00±11.76°on average . There was significant difference (P <0.01).Conclusion:The three-dimensional CT reconstruction had many advantages on full view of calcaneal fracture, it allowed calcaneal fracture classification and quantification of relevant displacement of fragments by surgeons to guide surgical treatment, clinical diagnosis and guidance of operation has important significance. It is important to regain the flatness of subtalar joint and calcaneocuboid joint , maintain the normal shape of foot. The CT typing is helping to judge the collapsed extent of the post calcaneus articular surface. TypeⅠB, typeⅠC, typeⅡB, typeⅡC,typeⅡD and typeⅢfractures of calcaneus according classification of three-dimensional reconstruction should be actively treated with open reduction and internal fixation . With the number of fracture lines and fracture site increased, the excellent and good rate will drop.