Lemerle R, Zucman J, Montagliari C, Dessagne F
Service de Chirurgie Orthopédique, Centre hospitalier Victor-Dupouy, Argenteuil.
Rev Chir Orthop Reparatrice Appar Mot. 1988;74(5):378-90.
In a series of 28 calcaneal fractures, computed tomography scanning has shown axial deformities in the coronal and horizontal (plantar) planes not previously recognized. Two-thirds of the fractures investigated showed a deformity in at least two planes. A combination of dorsiflexion, valgus and adduction was present in one-third of the cases. This examination allowed a precise measure to be made of the enlargement of the calcaneus which very frequently occurs and was greater than 25 per cent in two-thirds of the cases. It makes it possible to visualize subtalar and calcaneocuboid incongruence with great precision and, in particular, to determine the size of the incongruous surface and its severity. Computed tomography scanning showed the existence of subtalar incongruity without depression of the thalamus, which is a concept which is not well recognized. It shows incongruity which is not evident on normal radiographs or, conversely, which may be falsely interpreted from deceptive pictures. The results of this study indicate that the usual classifications based on radiological examination are inadequate and need to be revised. The accuracy of this examination leads to the hope of more precise indications for treatment in the future.
在一组28例跟骨骨折中，计算机断层扫描显示出在冠状面和水平（足底）平面存在先前未被认识到的轴向畸形。三分之二接受检查的骨折在至少两个平面上显示出畸形。三分之一的病例存在背屈、外翻和内收的组合。这项检查能够精确测量跟骨非常常见的增大情况，三分之二的病例中跟骨增大超过25%。它能够非常精确地显示距下关节和跟骰关节的不匹配情况，尤其是能够确定不匹配表面的大小及其严重程度。计算机断层扫描显示存在距下关节不匹配但丘脑无凹陷，这是一个尚未得到充分认识的概念。它显示出在正常X线片上不明显的不匹配情况，或者相反，可能会从具有欺骗性的图像中被错误解读。这项研究的结果表明，基于放射学检查的常规分类是不充分的，需要修订。这项检查的准确性让人对未来更精确的治疗指征充满希望。
