Leung K S, Yuen K M, Chan W S
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
J Bone Joint Surg Br. 1993 Mar;75(2):196-201. doi: 10.1302/0301-620X.75B2.8444936.
Since 1986, we have treated displaced intra-articular fractures of the calcaneum by open reduction through a lateral approach, stable internal fixation and bone grafting. We assessed the results at a mean follow-up of 2.92 years in 44 patients, comparing them with those for 19 patients treated non-operatively. Clinical assessment used the scoring system of Crosby and Fitzgibbons (1990) and radiological measurements were made from lateral, axial and internal oblique views. The articular congruity of the subtalar joint and any arthritic changes were also assessed. We found significantly better results in the operated group with respect to pain, activity, range of movement, return to work and swelling of the hind foot. Radiologically, the operated group showed significantly better scores for articular congruity and arthritic changes. We conclude that the operative treatment of displaced intra-articular fractures of the calcaneum gives better medium-term results than conservative management.
自1986年以来，我们采用外侧入路切开复位、稳定内固定及植骨的方法治疗跟骨关节内移位骨折。我们对44例患者进行了平均2.92年的随访评估，并将结果与19例非手术治疗的患者进行比较。临床评估采用Crosby和Fitzgibbons（1990年）的评分系统，通过侧位、轴位和内斜位X线片进行影像学测量。同时评估距下关节的关节一致性及任何关节炎变化。我们发现手术组在疼痛、活动能力、活动范围、恢复工作及后足肿胀方面的结果明显更好。在影像学上，手术组在关节一致性和关节炎变化方面的评分明显更高。我们得出结论，跟骨关节内移位骨折的手术治疗比保守治疗能取得更好的中期效果。
