Sbragia P, Zanfranceschi G, Niccolai F, Piperno G
Servizio di Radiologia, Ospedale Del Ceppo, Pistoia.
Radiol Med. 1991 Sep;82(3):265-9.
Calcaneal fractures account for 33.3% of foot fractures and 1.5% of all fractures. They were divided by Warrick and Brenner into two main groups according to whether they modify the astragalocalcaneal joint or not. Given the anatomical complexity of the foot, conventional X-rays are not always able to correctly visualize the articular facets and therefore provide insufficient information as to the characteristics of the fracture line, the position of bone fragments, and the involvement of capsulo-ligamentous structures. The authors report their personal experience with CT in the study of 12 patients with monolateral calcaneal fractures previously diagnosed on conventional X-rays. High-resolution CT (HRCT) was employed with 3-mm contiguous sections on the axial and the coronal planes. CT was used to study the normal anatomy of the foot and to evaluate 3 patients with calcaneal fracture without impaction of the posterior facet; 9 patients with impaction into the calcaneal body were also examined with CT. In the first 3 cases, an oblique fracture line was observed crossing from craniolateral to mediocaudal and thus dividing the calcaneus into 2 large fragments: sustentaculum tali and posterior facet of the talar joint. In the extant 9 cases the impaction of the posterior facet was indicated by an interruption in lateral and/or medial calcaneal walls. In 2/9 cases bone fragments were seen in the tarsal sinus, in 4/9 the sustentacular fragment was displaced, in 2 the cuboid bone was impacted into the anterior process of the calcaneus and, finally, in 7/9 cases a lateral/medial dislocation of the calcaneal tuberosity was observed. On the basis of these results, CT proved to be of greater value than conventional X-rays in the imaging of calcaneal fractures and to have a fundamental role every time an accurate evaluation of the region is needed to plan treatment.
跟骨骨折占足部骨折的33.3%,占所有骨折的1.5%。沃里克和布伦纳根据是否累及距跟关节将其分为两大主要类型。鉴于足部解剖结构复杂,传统X线片并不总能正确显示关节面,因此在骨折线特征、骨块位置以及关节囊韧带结构受累情况方面提供的信息不足。作者报告了他们在研究12例先前经传统X线片诊断为单侧跟骨骨折患者时使用CT的个人经验。采用高分辨率CT(HRCT),在轴向和冠状面上进行3毫米连续扫描。CT用于研究足部正常解剖结构,并对3例后关节面无塌陷的跟骨骨折患者进行评估;9例跟骨体有塌陷的患者也接受了CT检查。在前3例中,观察到一条斜行骨折线从颅外侧向中尾侧穿过,从而将跟骨分为2个大骨块:载距突和距骨关节后关节面。在其余9例中,外侧和/或内侧跟骨壁中断提示后关节面塌陷。在9例中的2例中,在跗骨窦内可见骨块,9例中的4例载距突骨块移位,2例骰骨嵌入跟骨前突,最后,在9例中的7例中观察到跟骨结节外侧/内侧脱位。基于这些结果,CT在跟骨骨折成像中被证明比传统X线片更有价值,并且每当需要对该区域进行准确评估以制定治疗方案时,CT都具有重要作用。