Carr J B
Division of Orthopaedic Surgery, Medical College of Virginia Hospitals, Richmond.
Orthop Clin North Am. 1994 Oct;25(4):665-75.
The acute displaced intra-articular calcaneus fracture should be approached on a rational basis. Minimally displaced fractures are best treated with early motion and delayed bearing of weight. Reconstructible, displaced fractures are probably best treated with exact open reduction and internal fixation, assuming contraindications such as poor skin condition or underlying disease are not present. The severely displaced, Sanders-type IV fractures remain a dilemma, and these may demonstrate a role for primary fusion in select instances. If one chooses to treat a calcaneus fracture surgically, it should be recognized that the result will be related to the exactness of the reduction. This surgery is very challenging, with an arduous learning curve. Importantly, if one cannot obtain an anatomic reduction, the patient may have been better off treated nonoperatively.
急性移位性关节内跟骨骨折的治疗应基于合理的原则。轻度移位骨折最好采用早期活动和延迟负重治疗。对于可重建的移位骨折，若不存在如皮肤状况差或基础疾病等禁忌证，可能采用精确的切开复位内固定治疗效果最佳。严重移位的Sanders Ⅳ型骨折仍然是一个难题，在某些特定情况下可能显示出一期融合的作用。如果选择手术治疗跟骨骨折，应认识到结果将与复位的精确程度相关。这种手术极具挑战性，学习曲线很陡。重要的是，如果无法获得解剖复位，患者接受非手术治疗可能会更好。
