Thermann H, Krettek C, Hüfner T, Schratt H E, Albrecht K, Tscherne H
Trauma Department, Hannover Medical School, Germany.
Clin Orthop Relat Res. 1998 Aug(353):107-24. doi: 10.1097/00003086-199808000-00013.
Significant progress had been made in the management of calcaneal fractures. This is reflected in the marked decrease in complication rates associated with the current intervention of these potentially devastating injuries. The treatment priorities that are key to achieve best results in a displaced calcaneal fracture are an anatomic reconstruction of the entire calcaneus including articular surfaces, height, alignment, and length, with a function directed postoperative management. The value of these priorities is confirmed by long term followup results. Conservative treatment should be considered only in cases of extraarticular fractures, in cases of minor displaced intraarticular fractures in patients who are nonambulatory, and in cases where there is a clear contraindication for surgery. An anatomic reconstruction of an os calcis fracture is difficult to obtain. In two-part fractures, according to the classification described by Sanders et al, an anatomic reduction is obtainable in more than 80% of cases. However, if the articular cartilage damage that is typically present is considered, a 70% rate of good to excellent clinical results is more realistic. In three-part fractures, anatomic reduction is attainable in approximately 60% of cases with a 70% rate of good results. These two subgroups comprise approximately 90% of all calcaneal fractures. It has been put into practice recently to optimize the extended lateral approach using posteromedial and anterolateral windows, so that an anatomic reduction can be achieved in more than 60% of os calcis fractures considered as Type III according to the classification described by Sanders et al. Additional scientific work in this area of trauma orthopaedics would benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5-year followup studies using these treatment methods and evaluation systems.
跟骨骨折的治疗已取得显著进展。这体现在与当前针对这些可能造成严重破坏的损伤的干预措施相关的并发症发生率显著下降。对于移位性跟骨骨折，要取得最佳治疗效果的关键治疗要点包括对整个跟骨进行解剖重建，包括关节面、高度、对线和长度，并进行功能导向的术后管理。这些要点的价值已得到长期随访结果的证实。仅在以下情况可考虑保守治疗：关节外骨折、非行走患者的轻度移位关节内骨折以及存在明确手术禁忌证的情况。跟骨骨折的解剖重建很难实现。在两部分骨折中，根据Sanders等人描述的分类，超过80%的病例可实现解剖复位。然而，如果考虑到通常存在的关节软骨损伤，70%的优良临床效果率更为现实。在三部分骨折中，约60%的病例可实现解剖复位，优良效果率为70%。这两个亚组约占所有跟骨骨折的90%。最近已在实践中优化使用后内侧和前外侧窗口的延长外侧入路，以便根据Sanders等人描述的分类，在超过60%的III型跟骨骨折中实现解剖复位。创伤骨科这一领域的更多科学工作将最受益于就骨折分类系统和临床评分系统达成普遍共识，并采用这些治疗方法和评估系统进行5年随访研究。
