Brunner U H, Betz A, Halama R
Chirurgische Klinik, Ludwig-Maximilians-Universität München.
Orthopade. 1991 Mar;20(1):55-66.
The treatment of intra-articular fractures of os calcis has so far been controversial. For reconstruction of static and dynamic conditions of the foot, complex deformities must be corrected. Besides intra-articular malformation of the talocalcaneal joint that is supposed to lead to posttraumatic arthritis, there are malalignments like lateral displacement, widening and shortening of the heel, depression of talocalcaneal angles and deviation of talocalcaneal or talocuboidal axes. Even if perfect reconstruction of the talocalcaneal joint is not attained, reconstruction of form will provide a better chance for later function. ORIF is therefore superior to conservative techniques. For indication and planning of the procedure fracture analysis including CT is necessary. A lateral approach allows reconstruction and plate fixation of all intra-articular fracture types. For repositioning, temporary lateral external distraction by external fixation is recommended. The operative technique and results are discussed.
跟骨关节内骨折的治疗至今仍存在争议。为重建足部的静态和动态状况，必须纠正复杂的畸形。除了距下关节的关节内畸形可能导致创伤后关节炎外，还存在如足跟的外侧移位、增宽和缩短、距跟角凹陷以及距跟或距骰轴线偏移等对线不良情况。即使无法实现距下关节的完美重建，外形的重建也会为后期功能提供更好的机会。因此，切开复位内固定术优于保守技术。对于该手术的适应证和规划，包括CT在内的骨折分析是必要的。外侧入路可对所有关节内骨折类型进行重建和钢板固定。对于复位，建议通过外固定进行临时外侧外牵引。文中讨论了手术技术及结果。
