Albert-Ludwigs University Freiburg, Department Orthopaedics and Traumatology, Freiburg, Germany.
Injury. 2011 Oct;42(10):1135-43. doi: 10.1016/j.injury.2010.09.040. Epub 2010 Nov 13.
Fractures of the calcaneus are often associated with serious permanent disability, a considerable reduction in quality of life, and high socio-economic cost. Although some studies have already reported changes in plantar pressure distribution after calcaneal fracture, no investigation has yet focused on the patient's strength and postural control.
60 patients with unilateral, operatively treated, intra-articular calcaneal fractures were clinically and biomechanically evaluated >1 year postoperatively (physical examination, SF-36, AOFAS score, lower leg isokinetic strength, postural control and gait analysis including plantar pressure distribution). Results were correlated to clinical outcome and preoperative radiological findings (Böhler angle, Zwipp and Sanders Score).
Clinical examination revealed a statistically significant reduction in range of motion at the tibiotalar and the subtalar joint on the affected side. Additionally, there was a statistically significant reduction of plantar flexor peak torque of the injured compared to the uninjured limb (p<0.001) as well as a reduction in postural control that was also more pronounced on the initially injured side (standing duration 4.2±2.9s vs. 7.6±2.1s, p<0.05). Plantar pressure measurements revealed a statistically significant pressure reduction at the hindfoot (p=0.0007) and a pressure increase at the midfoot (p=0.0001) and beneath the lateral forefoot (p=0.037) of the injured foot. There was only a weak correlation between radiological classifications and clinical outcome but a moderate correlation between strength differences and the clinical questionnaires (CC 0.27-0.4) as well as between standing duration and the clinical questionnaires. Although thigh circumference was also reduced on the injured side, there was no important relationship between changes in lower leg circumference and strength suggesting that measurement of leg circumference may not be a valid assessment of maximum strength deficits. Self-selected walking speed was the parameter that showed the best correlation with clinical outcome (AOFAS score).
Calcaneal fractures are associated with a significant reduction in ankle joint ROM, plantar flexion strength and postural control. These impairments seem to be highly relevant to the patients. Restoration of muscular strength and proprioception should therefore be aggressively addressed in the rehabilitation process after these fractures.
跟蹤随访超过 1 年，我们评估了 60 例经手术治疗的、有症状的、关节内跟骨骨折患者的临床和生物力学情况，评估内容包括（体格检查、SF-36 评分、AOFAS 评分、小腿等速肌力、姿势控制和步态分析，包括足底压力分布）。将结果与临床结果和术前影像学发现（Böhler 角、Zwipp 和 Sanders 评分）相关联。
临床检查显示患侧距下关节和踝穴的活动范围明显减小。与健侧相比，受伤侧的跖屈肌峰值力矩明显减小（p<0.001），姿势控制也明显更差，最初受伤的那一侧更明显（站立持续时间 4.2±2.9s 对 7.6±2.1s，p<0.05）。足底压力测量显示，患足的后足（p=0.0007）、中足（p=0.0001）和外侧前足（p=0.037）的压力明显减小。影像学分类与临床结果仅呈弱相关，但与肌力差异（CC 0.27-0.4）和站立时间与临床问卷之间存在中度相关。患侧大腿周径也减小，但小腿周径的变化与肌力之间没有重要关系，这表明测量小腿周径可能不是评估最大肌力缺陷的有效方法。自我选择的步行速度是与临床结果（AOFAS 评分）相关性最好的参数。
跟骨骨折会导致踝关节活动范围减小、跖屈肌力和姿势控制能力下降。这些损伤对患者的影响非常大。因此，在骨折康复过程中，应积极解决肌肉力量和本体感觉的恢复问题。
