Evers J, Oberste M, Wähnert D, Grüneweller N, Wieskötter B, Milstrey A, Raschke M J, Ochman S
Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland.
Unfallchirurg. 2019 Oct;122(10):778-783. doi: 10.1007/s00113-018-0578-4.
After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted.
Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures.
Between 2005 and 2013 a total of 90 patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis. A total of 48 patients with 55 fractures were retrospectively investigated. The assessment with respect to posttraumatic arthrosis was made radiologically and Böhler's and Gissane's angles were also determined. Clinically AOFAS and SF-36 scores were documented. The results were statistically tested with respect to possible risk factors.
A total of 9 patients (18.8%) were found with complications necessitating operative revision, with 8 patients requiring subtalar arthrodesis and 1 patient with a deep wound infection. Nicotine abuse and a long interval between trauma and reconstructive surgery were identified as factors that influenced the development of wound healing problems. The average AOFAS score was 68 points and the SF-36 was 58.86 points. A poor result in the scores was caused by the development of symptomatic arthritis and the type of insurance. In this cohort factors, such as age and complexity of fractures were not correlated with a poor result.
In this patient collective nicotine abuse and a long interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.
在关于跟骨骨折治疗方案的文献中出现有争议的讨论之后，对一家特级护理创伤中心接受手术治疗的患者进行了一项回顾性研究。
调查影响手术治疗的跟骨骨折患者治疗质量的因素。
2005年至2013年期间，该医院共对90例跟骨骨折患者采用锁定钢板内固定术进行了手术治疗。对其中48例患者的55处骨折进行了回顾性研究。通过影像学评估创伤后关节炎情况，并测定Böhler角和Gissane角。临床记录AOFAS和SF-36评分。对结果就可能的危险因素进行统计学检验。
共发现9例患者（18.8%）出现需要手术翻修的并发症，其中8例患者需要距下关节融合术，1例患者发生深部伤口感染。发现滥用尼古丁以及创伤与重建手术之间间隔时间长是影响伤口愈合问题发生的因素。AOFAS平均评分为68分，SF-36评分为58.86分。评分结果不佳是由症状性关节炎的发生和保险类型导致的。在该队列中，年龄和骨折复杂性等因素与结果不佳无关。
在该患者群体中，滥用尼古丁以及创伤与手术之间间隔时间长是伤口感染发生的危险因素。对结果有影响的其他因素是术后关节炎的发生和健康保险类型；然而，患者年龄对结果没有影响。
