糖尿病患者跟骨骨折影像学表现与病因学分析

Imaging Manifestations and Etiologic Analyses of Calcaneal Fractures in Diabetic Patients

目的 评价糖尿病患者跟骨骨折的影像学表现并探讨其病因。方法 回顾过去 7年期间X线平片检查发现具有跟骨骨折的 37例糖尿病患者 ,追踪其临床表现及治疗情况。结果 37例患者 33例为Ⅰ型糖尿病 ,4例为Ⅱ型糖尿病。跟骨骨折表现为三种类型 :Iowa型骨折 (跟骨后部关节外撕脱性骨折并向上移位 ) 1 8例 (第一组 ) ;跟骨体中部压缩型骨折 1 1例 (第二组 ) ;起始于跟骨结节的分裂型或楔型骨折 8例 (第三组 )。 2 0例患者有肾功能不全或肾功能衰竭 ,其中 1 3例进行过肾移植 ,并接受长期、大量的类固醇治疗。 1 0例患者在骨折前有为减轻体重负荷的治疗。第三组患者均有慢性穿透性足跟溃疡史。结论 对于足或踝关节疼痛和肿胀的糖尿病患者 ,跟骨骨折的发生率较高 ,应常规摄取X线平片 。

Objective To evaluate the imaging manifestations of calcaneal fractures in diabetic patients and explore their etiological factors.Methods Thirty seven diabetic patients with calcaneal fractures over the past seven years were analyzed retrospectively,and their clinical presentation and therapeutic history prior to the calcaneal fractures were also investigated.Results Thirty three of the 37 patients had type Ⅰ diabetes mellitus (DM),the remaining 4 had type Ⅱ DM.There appear to be three basic fracture types:(the group 1) a superiorly displaced extra articular avulsion fracture of the posterior calcaneus (or Iowa fracture),which occurred in 18 patients,(the group 2) a mid calcaneal compression fracture in 11 patients,and (the group 3) a “cleavage or wedge” type fracture in 8 patients extending from the calcaneal tubercle.All eight of this last group of patients had a history of a chronic penetrating heel ulcer.Twenty patients had either poor renal function or complete renal failure,13 of them had received a renal transplant,and were on long term,high dose steroids.Ten patients were on restricted weight bearing preceding their fractures.Conclusion This study supports that conventional radiographs be obtained in any diabetic patient with foot or ankle pain and/or swelling.These patients are at high risk for fracture,and early treatment may prevent bony deformities.