Eastwood D M, Langkamer V G, Atkins R M
Department of Orthopaedic Surgery, Bristol Royal Infirmary, UK.
J Bone Joint Surg Br. 1993 Mar;75(2):189-95. doi: 10.1302/0301-620X.75B2.8444935.
The classification of intra-articular fractures of the calcaneum described in part I is related to an operative approach which allows accurate reduction and stable fixation of the fracture fragments. An extended lateral incision is used to avoid sural nerve damage and problems of soft-tissue healing. In type 3 fractures, access to the lateral joint fragment requires an osteotomy of the lateral wall, but after this the lateral joint fragment can be rotated out of the subtalar joint to allow transcalcaneal reduction of the medial wall. Reduction of the body fragment and lateral joint fragment on to the sustentacular fragment allows the three fragments to be stabilised by a 3.5 mm Y-shaped reconstruction plate. Our early results have been successful in terms of fracture reduction and the restoration of heel shape and joint congruity, but extended follow-up will be necessary to define the indications for this difficult procedure.
第一部分中所描述的跟骨关节内骨折的分类与一种手术入路相关，该入路能实现骨折碎片的精确复位及稳定固定。采用延长外侧切口以避免腓肠神经损伤及软组织愈合问题。在3型骨折中，要显露外侧关节面碎片需行外侧壁截骨术，但截骨后可将外侧关节面碎片从距下关节转出，以便对内侧壁进行经跟骨复位。将体部碎片和外侧关节面碎片复位至载距突碎片上，可用一块3.5毫米的Y形重建钢板使三块碎片得到稳定。就骨折复位以及足跟外形和关节一致性的恢复而言，我们的早期结果是成功的，但需要延长随访时间来明确这一复杂手术的适应证。
