跟骨骨折后跟垫厚度测量的临床意义

Measurement of heel pad thickness following calcaneal fractures

目的探讨跟骨骨折后是否出现跟垫损伤、变薄或增厚，跟垫特性改变是否与足跟痛相关。方法自2001年5月至2004年12月选择跟骨骨折患者18例，纳入标准为：①单足损伤；②年龄20—55岁；③平时无足跟痛表现。于入院1周内摄双足跟骨非负重下标准侧位及轴位X线片，并以侧位片测量跟骨与跖部皮肤表面最短距离作为跟垫厚度，随访时（骨折愈合后）再拍摄负重与非负重下双足跟骨标准侧位及轴位X线片，亦测量跟垫厚度，计算双足跟垫厚度及压缩性系数的平均值。同时记录骨折足跟部症状，观察骨折复位状况。结果入院1周内对照足和骨折足不负重时跟垫厚度分别为（21．23±2．24）mm和（21．63±2．54）mm，差异无统计学意义（t=0．50，P〉0．05）。随访时（骨折愈合后）：对照足和骨折足不负重时跟垫厚度分别为（21．31±2．21）mm和（23．11±2．24）mm，差异有统计学意义（t=2．44，P〈0．05）；对照足和骨折足负重时跟垫厚度分别为（10．35±1．72）mm和（12．75±1．98）mm，差异有统计学意义（t=3．94，P〈0．05）；对照足和骨折足跟垫压缩性系数分别为0．45±0．11和0．58±0．14，差异无统计学意义（t=0．92，P〉0．05）。结论跟骨骨折后，可因受暴力大小、骨折移位影响，在一些患者中导致跟垫损伤，致使跟垫厚度变化，尤其是跟垫压缩性系数变大（意味着跟垫弹性减低），这可能是导致足跟痛的原因之一，治疗中保护好跟垫组织，减少二次损伤，可减少跟骨骨折后并发症。

Objective To study whether the heel pad will have changes in thickness or injury following calcaneal fractures and whether they are correlated to heel pain. Methods Subjects were chosen randomly from the patients who had suffered unilateral calcaneal fractures between May 2001 and December 2004, had an age between 20 and 55 years, and experienced no constant heel pain before fracture. In the first week of hospitalization, standard lateral and axial radiographs were taken for bilateral calcanei without weight loading. The shortest distance between the calcaneus and the skin of heel in the lateral radiograph was measured as the heel pad thickness. In the follow-up after fracture union, the standard lateral and axial X-ray photographs of the bilateral calcanei with and without weight loading were taken again. The thickness of heel pad was also measured again. The average bilateral heel pad thickness and the heel pad compressibility were calculated. At the same time, symptoms of the injured heel were recorded and the fracture reduction observed. Results In the first week of hospitalization, the heel pad thickness without weight-loading was 21.63 ± 2.54 mm at the fractured side and 21.23 ±2. 24 mm at the opposite side, the difference between the two showing no statistic significance （ t =0. 50, P 〉 0. 05）. In the follow-up （after union of fractures）, the above two sets of data became 23.11 ±2. 24 mm and 21.31 ±2. 21 mm respectively, the difference showing statistic significance （ t = 2. 44, P 〈 0. 05）. And the mean thickness with weight-loading was 12. 75 ± 1.98 mm for the fractured foot and 10. 35 ± 1.72 mm for the opposite foot respectively, with remarkable statistic difference （ t =3.94, P 〈 0. 05）. The heel pad compressibility quotient （ratio of the heel pad thickness with to without weight-loading） was 0.45 ±0. 11 at the control side, but 0. 58 ±0. 14 at the fractured side, without statistically significant difference （ t = 0. 92, P 〉 0. 05）. Conclusions Heel pad injury can arise in patients following calcaneal fractures, maybe due to violent force or displacement. The injury may cause changes in heel pad thickness, and increased heel pad compressibility quotient in particular, indicating loss of heel pad elasticity. This may be one of the causes of heel pain. Protecting the heel pad tissue and reducing secondary injury to the heel pad will reduce complications after calcaneal fractures.