Crosby L A, Fitzgibbons T
Division of Orthopaedic Surgery, Creighton University School of Medicine, Omaha, Nebraska 68131.
J Bone Joint Surg Am. 1990 Jul;72(6):852-9.
Computerized tomography was used to evaluate thirty intra-articular fractures of the calcaneus in twenty-seven patients. A classification of the fractures was devised on the basis of fracture patterns involving the posterior facet joint of the calcaneus. In Type I, the fracture fragments were small or not displaced; in Type II, they were displaced; and in Type III, they were comminuted. There were thirteen Type-I, ten Type-II, and seven Type-III fractures, all of which were treated with a variety of closed methods. The length of follow-up ranged from eighteen to fifty-two months (mean, thirty-six months). The results were graded by a predetermined point system that included the evaluation of motion of the subtalar joint. Of the thirteen Type-I fractures, eight had an excellent result; four, a good result; and one, a fair result. Of the ten Type-II fractures, two had a good result; four, a fair result; and four, a poor result. All of the seven Type-III fractures had a poor result. On the basis of our study of the fracture patterns as seen on the computerized tomography scans, we believe that it is possible to predict which fractures will do well with closed treatment and which will not. Type-I fractures did well with closed treatment. Type-II fractures can be treated closed but with a lower success rate than Type-I fractures. All of the Type-III fractures had a poor result after closed treatment.
采用计算机断层扫描对27例患者的30例跟骨关节内骨折进行评估。根据涉及跟骨后关节面的骨折类型设计了一种骨折分类方法。I型骨折，骨折碎片小或无移位；II型骨折，骨折碎片有移位；III型骨折，骨折碎片粉碎。I型骨折13例，II型骨折10例，III型骨折7例，所有骨折均采用多种闭合方法治疗。随访时间为18至52个月（平均36个月）。结果根据预定的评分系统进行分级，该系统包括对距下关节活动的评估。13例I型骨折中，8例结果优秀；4例结果良好；1例结果尚可。10例II型骨折中，2例结果良好；4例结果尚可；4例结果差。7例III型骨折结果均差。基于我们对计算机断层扫描所见骨折类型的研究，我们认为有可能预测哪些骨折采用闭合治疗效果良好，哪些效果不佳。I型骨折采用闭合治疗效果良好。II型骨折可以采用闭合治疗，但成功率低于I型骨折。所有III型骨折采用闭合治疗后效果均差。
