Huefner T, Thermann H, Geerling J, Pape H C, Pohlemann T
Trauma Department, Hannover Medical School, Germany.
Foot Ankle Int. 2001 Jan;22(1):9-14. doi: 10.1177/107110070102200102.
We evaluated retrospectively the long-term results of isolated calcaneal fractures treated with open reduction and internal fixation and a primary subtalar arthrodesis. From 1990 to 1997 258 patients were treated with a calcaneal fracture, for the current study six patients were included. Six different surgeons operated on the patients. The indication for the fusion was based on the comminution of the posterior facet according to the preoperative CT as well as the intraoperative evaluation of destruction of the cartilage. The restoration of length, axes and angles of the calcaneus was almost anatomical in all cases. Follow-up was done at a mean of 4.9 (2.5 - 7.5 years). Using the AOFAS score, the results were good or excellent in five patients. In one patient with a painful arthritis in the talonavicular joint and hyperesthesia of the sural nerve, the results were fair. All returned to their profession within 9 months and had no or only minor daily restrictions. The results are comparable with single surgeon series. We found open reconstruction of the calcaneus with primary fusion of the subtalar joint may be indicated in selected patients and, in these 6 patients led to good results.
我们回顾性评估了切开复位内固定及一期距下关节融合术治疗单纯跟骨骨折的长期疗效。1990年至1997年期间，258例患者接受了跟骨骨折治疗，本研究纳入了其中6例患者。6名不同的外科医生为这些患者实施了手术。融合的指征基于术前CT显示的后关节面粉碎情况以及术中对软骨破坏情况的评估。所有病例中跟骨的长度、轴线和角度恢复几乎均达到解剖复位。平均随访4.9年（2.5 - 7.5年）。采用美国足与踝关节协会（AOFAS）评分，5例患者结果为优或良。1例患者距舟关节疼痛性关节炎且腓肠神经感觉过敏，结果为一般。所有患者均在9个月内重返工作岗位，日常活动无受限或仅有轻微受限。结果与单一外科医生的系列研究相当。我们发现，对于部分选定患者，切开复位重建跟骨并一期融合距下关节可能是合适的，在这6例患者中取得了良好效果。
