Kuner E H, Bonnaire F, Hierholzer B
Abteilung Unfallchirurgie, Albert-Ludwigs-Universität Freiburg.
Unfallchirurg. 1995 Jun;98(6):320-7.
In the treatment of fractures of the calcaneus, the particularly intricate local anatomy, complicated fracture forms and associated soft tissue damage often prejudice operative, anatomical reconstruction. We propose a simplified classification that is based on the Regazzoni classification of 1993 and has six grades of severity. It can be helpful in the selection of operative treatment and, above all, make it possible to recognize whether operative reconstruction is possible and appropriate. When operative reconstruction is indicated we find the secondary operation important; it is also important to diagnose and treat compartment syndrome if present and otherwise to take steps to prevent it. In the first phase, in special cases we use an external fixator without reconstruction of the full length. The operative technique is largely standardized as as the fixator is placed only temporarily. Correct positioning allows easy correction of shortening or varus deformation, and joint surface reconstruction is also feasible. Autologous bone grafting is possible. The definitive fixation is achieved with internal plate stabilization by a lateral approach and removal of the fixator. Contraindications for this procedure are burst fractures with total destruction of the joint surfaces and cartilage. Out of 54 fractures we used the fixator to aid reduction in 45. In 71% of these we had very good and good results according to the Merle d'Aubigné scoring system.
在跟骨骨折的治疗中，其局部解剖结构特别复杂，骨折形式多样且伴有软组织损伤，这常常不利于进行手术解剖重建。我们提出一种简化分类方法，该方法以1993年雷加佐尼分类为基础，有六个严重程度等级。它有助于选择手术治疗方法，最重要的是，能够判断手术重建是否可行及合适。当需要进行手术重建时，我们认为二次手术很重要；诊断和治疗骨筋膜室综合征（如果存在的话）也很重要，否则要采取措施预防。在第一阶段，在特殊情况下我们使用外固定器，但不进行全长重建。由于外固定器只是临时放置，手术技术在很大程度上是标准化的。正确定位便于轻松纠正短缩或内翻畸形，关节面重建也是可行的。自体骨移植也是可能的。最终通过外侧入路使用内固定钢板并拆除外固定器来实现确定性固定。该手术的禁忌证是关节面和软骨完全破坏的爆裂骨折。在54例骨折中，我们使用外固定器辅助复位45例。根据默尔·德·奥布涅评分系统，其中71%的病例取得了非常好和良好的效果。
