Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Bone Joint Surg Am. 2010 Dec 15;92(18):2884-9. doi: 10.2106/JBJS.J.00089.
Internal fixation is an accepted treatment for displaced fractures of the calcaneus. Operative intervention in older patients, however, is traditionally discouraged in the literature. The purpose of this study was to compare the outcomes of internal fixation of intra-articular fractures of the calcaneus on the basis of patient age.
One hundred and seventy-five patients (191 fractures) who underwent internal fixation between 1992 and 2007 for a displaced, intra-articular calcaneal fracture were identified. The American Society of Anesthesiologists score, the fracture pattern, and the mechanism of injury were recorded. Each patient was contacted to complete a follow-up survey from which clinical outcome scores were calculated. One hundred and forty-six patients with 158 fractures were available for follow-up and were divided into two groups for comparison. Group I consisted of 108 fractures in patients who were less than fifty years old. Group II was composed of fractures in fifty patients who were fifty years of age or older.
The mean duration of follow-up was 8.98 years. The average patient age was thirty-six years for Group I and fifty-eight years for Group II. The average adjusted American Orthopaedic Foot & Ankle Society score was 64 for Group I and 75 for Group II. The mean calcaneal fracture scoring system score was 66 for Group I, and 76 for Group II. Similarly, the average Foot Function Index was 24 and 15 for Groups I and II, respectively. Each clinical outcome measure suggests significantly better outcomes for Group II as compared with Group I (all p < 0.05). Overall, the complication rates were similar between groups. Conversion to subtalar fusion was 15% for Group I and 8% for Group II.
In this series, outcomes of older patients are at least equivalent to those of younger patients undergoing internal fixation for an intra-articular calcaneal fracture. Operative intervention appears to be a reasonable option for displaced calcaneal fractures in older patients. Physiologic age should be considered when evaluating older patients, and individualized treatment plans remain critical because patients with low physical demands or who have medical complications may be better candidates for nonoperative treatment. Prospective studies are needed in this area.
对于跟骨移位骨折，内固定是一种公认的治疗方法。然而，在文献中，传统上不鼓励对老年患者进行手术干预。本研究的目的是根据患者年龄比较跟骨关节内骨折内固定的结果。
我们确定了 1992 年至 2007 年间因移位关节内跟骨骨折接受内固定治疗的 175 名患者（191 处骨折）。记录了美国麻醉医师协会评分、骨折类型和损伤机制。每位患者都被联系完成随访调查，从中计算出临床结果评分。146 名患者（158 处骨折）可进行随访，并分为两组进行比较。I 组包括 108 例年龄小于 50 岁的患者。II 组由 50 名年龄在 50 岁或以上的患者的骨折组成。
平均随访时间为 8.98 年。I 组患者的平均年龄为 36 岁，II 组为 58 岁。I 组平均调整后的美国矫形足踝协会评分（American Orthopaedic Foot & Ankle Society score）为 64 分，II 组为 75 分。I 组的平均跟骨骨折评分系统（calcaneal fracture scoring system）评分为 66 分，II 组为 76 分。同样，I 组和 II 组的平均足部功能指数（Foot Function Index）分别为 24 和 15。每个临床结果测量都表明 II 组的结果明显优于 I 组（均 p < 0.05）。总体而言，两组的并发症发生率相似。I 组的转换为距下关节融合术的比例为 15%，II 组为 8%。
在本系列中，老年患者的结果至少与接受关节内跟骨骨折内固定的年轻患者相当。对于老年患者的移位跟骨骨折，手术干预似乎是一种合理的选择。在评估老年患者时应考虑生理年龄，个体化治疗方案仍然至关重要，因为低生理需求或有医疗并发症的患者可能更适合非手术治疗。该领域需要前瞻性研究。
