Schepers T, van Lieshout E M M, van Ginhoven T M, Heetveld M J, Patka P
Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, CA Rotterdam, The Netherlands.
Int Orthop. 2008 Oct;32(5):711-5. doi: 10.1007/s00264-007-0385-y. Epub 2007 Jun 13.
The treatment of intra-articular calcaneal fractures is controversial and randomised clinical trials are scarce. Moreover, the socio-economic cost remains unclear. The aim of this study was to estimate the incidence, treatment preferences and socio-economic cost of this complex fracture in the Netherlands. This data may aid in planning future clinical trials and support education. The method of study was of a cross-sectional survey design. A written survey was sent to one representative of both the traumatology and the orthopaedic staff in each hospital in the Netherlands. Data on incidence, treatment modalities, complications and follow-up strategies were recorded. The socio-economic cost was calculated. The average response rate was 70%. Fracture classifications, mostly by Sanders and Essex-Lopresti, were applied by 29%. Annually, 920 intra-articular calcaneal fractures (0.4% incidence rate) were treated, mainly with ORIF (46%), conservative (39%) and percutaneous (10%) treatment. The average non-weight-bearing mobilisation was 9 weeks (SD 2 weeks). An outcome score, mainly AOFAS, was documented by 7%. A secondary arthrodesis was performed in 21% of patients. The socio-economic cost was estimated to be euro21.5-30.7 million. Dutch intra-articular calcaneal fracture incidence is at least 0.4% of all fractures presenting to hospitals. Better insight into treatment modalities currently employed and costs in the Netherlands was obtained.
跟骨关节内骨折的治疗存在争议，且随机临床试验较少。此外，社会经济成本仍不明确。本研究的目的是估计荷兰这种复杂骨折的发病率、治疗偏好和社会经济成本。这些数据可能有助于规划未来的临床试验并支持教育工作。研究方法采用横断面调查设计。向荷兰每家医院的创伤科和骨科工作人员中的一名代表发送了书面调查问卷。记录了有关发病率、治疗方式、并发症和随访策略的数据，并计算了社会经济成本。平均回复率为70%。29%的人采用了骨折分类，大多依据桑德斯（Sanders）和埃塞克斯-洛普雷斯蒂（Essex-Lopresti）分类法。每年治疗920例跟骨关节内骨折（发病率为0.4%），主要治疗方式为切开复位内固定术（ORIF，46%）、保守治疗（39%）和经皮治疗（10%）。平均非负重活动时间为9周（标准差2周）。7%的人记录了结果评分，主要是美国足踝外科协会（AOFAS）评分。21%的患者进行了二期关节融合术。社会经济成本估计为2150万至3070万欧元。荷兰跟骨关节内骨折发病率至少占所有入院骨折的0.4%。对荷兰目前采用的治疗方式和成本有了更深入的了解。
