Paley D, Hall H
Division of Orthopaedic Surgery, Women's College Hospital, University of Toronto, Ontario, Canada.
J Bone Joint Surg Am. 1993 Mar;75(3):342-54. doi: 10.2106/00004623-199303000-00005.
Forty-four patients who had had fifty-two calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between four and fourteen years after the operation, with use of an evaluation system for the hindfoot and with plain radiographs. The characteristics of the patients that were associated with an unsatisfactory outcome were an age of more than fifty years, a greater body weight, work involving strenuous labor, and increased time missed from work due to the injury. Other prognostic variables associated with an unsatisfactory result included subtalar incongruity, osteoarthrosis of the talonavicular joint and the ankle, an increased heel width, a decreased fibulocalcaneal space, and a decreased Böhler-angle ratio of the fractured to the normal side. The heel height, fat-pad height, arch angle, talocalcaneal angle, and length of the Achilles-tendon fulcrum were not related to the outcome. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. Comminution of tongue and large central-depression fractures was associated with a worse prognosis. The most common most painful area in the patients who had a satisfactory outcome was the lateral aspect of the hindfoot, while in those who had an unsatisfactory result, it was the heel pad.
44例（共52处）跟骨骨折患者接受了切开复位内固定治疗。在术后4至14年期间，采用后足评估系统并结合X线平片对结果进行回顾性分析。与预后不佳相关的患者特征包括年龄超过50岁、体重较大、从事重体力劳动以及因伤误工时间延长。与结果不佳相关的其他预后变量包括距下关节不匹配、距舟关节和踝关节骨关节炎、足跟宽度增加、腓骨-跟骨间隙减小以及骨折侧与正常侧的Böhler角比值降低。足跟高度、脂肪垫高度、足弓角度、距骨-跟骨角度以及跟腱支点长度与预后无关。舌型骨折患者的结果优于中央凹陷骨折患者，而中央凹陷骨折患者的结果优于粉碎性骨折患者。舌型和大型中央凹陷骨折的粉碎与预后较差相关。预后良好的患者中最常见的疼痛部位是后足外侧，而预后不佳的患者中则是足跟垫。
