Ebraheim N A, Biyani A, Padanilam T, Christiensen G
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699, USA.
Foot Ankle Int. 1996 Sep;17(9):563-5. doi: 10.1177/107110079601700910.
The charts and radiographs of 48 surgically treated patients who underwent surgery for calcaneal fractures (right in 25 patients, left in 22, and bilateral in 1) between 1987 and 1994 were retrospectively reviewed. Coronal computed tomographic scans alone were obtained in 33 patients, and both coronal and axial computed tomographic scans were obtained in 9 patients. Three fractures exiting close to the calcaneocuboid joint (CCJ), but not involving the joint, were excluded. Nineteen patients (38.7%) had involvement of the CCJ. The extension of the fracture to the CCJ was apparent in anteroposterior or oblique radiographs or both in 18 patients. There was intra-articular fracture displacement of < or = 1 mm in 6 patients, and 13 patients had a step or a gap of > or = 2 mm with or without angulation. Eleven patients had joint depression type fractures, 6 had tongue type fractures, and 2 had comminuted fractures. Extension of the calcaneal fracture into the CCJ was significantly more common with the joint depression type calcaneal fractures (chi-square test; P = 0.008). The coronal computed tomographic images showed significant lateral subluxation of posterior facet fragments in 8 patients and considerable comminution of the lateral calcaneal wall with or without lateral subluxation of posterior facet fragment in 10 patients. These patients also had CCJ involvement, thus establishing a strong correlation between lateral subluxation of the posterior facet fragment or comminution of the lateral calcaneal wall and CCJ involvement. CCJ involvement is more common with joint depression type fractures. Extension of the fracture line into the CCJ should be suspected in presence of significant lateral column comminution or lateral talar subluxation.
回顾性分析了1987年至1994年间48例接受手术治疗的跟骨骨折患者的病历和影像学资料。其中25例为右侧跟骨骨折，22例为左侧，1例为双侧。33例患者仅行冠状位计算机断层扫描（CT），9例患者同时行冠状位和轴位CT扫描。排除3例骨折线靠近跟骰关节（CCJ）但未累及该关节的病例。19例患者（38.7%）累及CCJ。18例患者在前后位或斜位X线片或两者上均可见骨折线延伸至CCJ。6例患者关节内骨折移位≤1mm，13例患者有≥2mm的台阶或间隙，伴或不伴成角。11例患者为关节塌陷型骨折，6例为舌型骨折，2例为粉碎性骨折。关节塌陷型跟骨骨折中，跟骨骨折延伸至CCJ明显更为常见（卡方检验；P=0.008）。冠状位CT图像显示，8例患者后关节面碎片明显外侧半脱位，10例患者跟骨外侧壁明显粉碎，伴或不伴后关节面碎片外侧半脱位。这些患者也累及CCJ，从而证实后关节面碎片外侧半脱位或跟骨外侧壁粉碎与CCJ累及之间存在密切相关性。CCJ累及在关节塌陷型骨折中更为常见。当存在明显的外侧柱粉碎或距骨外侧半脱位时，应怀疑骨折线延伸至CCJ。
