O'Farrell D A, O'Byrne J M, McCabe J P, Stephens M M
Department of Orthopaedic Surgery, Mater Misericordiae Hospital, Dublin, Ireland.
Injury. 1993 Apr;24(4):263-5. doi: 10.1016/0020-1383(93)90183-7.
A prospective study of 24 patients with displaced intra-articular fractures of the os calcis was performed to compare operative with non-operative treatment. Twelve patients were treated by internal fixation followed by early mobilization, and 12 were managed non-operatively. The patients were assessed 15 months later using eight parameters. Of the 12 patients who were treated by internal fixation, eight had returned to work. Walking distance was significantly longer (4 km) in this group and only one patient needed a change in shoe size. Of the 12 patients who were managed non-operatively, only three had returned to work and eight had a change in shoe size, while the average walking distance without pain was only 1 km. The mean range of subtalar movement was 24 degrees in the operated group but only 12 degrees in the other group (P < 0.05). Radiological follow-up demonstrated partial or full restoration of Böhler's angle in the patients who underwent internal fixation. We recommend plating of displaced intraarticular os calcis fractures through a lateral approach in patients under 40 years of age.
对24例跟骨关节内移位骨折患者进行了一项前瞻性研究，以比较手术治疗与非手术治疗的效果。12例患者接受内固定治疗并早期活动，12例接受非手术治疗。15个月后使用8项指标对患者进行评估。在接受内固定治疗的12例患者中，8例已恢复工作。该组患者的行走距离明显更长（4公里），只有1例患者需要更换鞋码。在接受非手术治疗的12例患者中，只有3例恢复工作，8例更换了鞋码，而无痛情况下的平均行走距离仅为1公里。手术组距下关节平均活动范围为24度，另一组仅为12度（P<0.05）。影像学随访显示，接受内固定治疗的患者Böhler角部分或完全恢复。我们建议对40岁以下的跟骨关节内移位骨折患者采用外侧入路钢板内固定治疗。
