跟骨的形态结构特点及其临床意义

Morphological character of calcaneus and its clinical significance

目的 :为跟骨骨折的治疗提供形态学的依据和标准。方法 :观察成人正常跟骨的形态特征和骨小梁分布情况 ,测量跟骨的长、宽、高和Bohler′s角、Gissane′s角等。结果 :①跟骨形态结构较复杂 ,骨皮质薄 ,骨松质多 ,跟骨前部跟骨沟下方骨小梁稀疏 ,后部内侧骨小梁密集。②正常跟骨各指标左右两侧无明显差异 ,而不同性别间除Gissane′s角外 ,其他各项指标均有显著差异 ;跟骨高 /长的比值 >1/2。结论 :①跟骨形态学上存在力学薄弱点 ,易骨折 ,骨折多数复杂。②正常跟骨高 /长比例固定 >1/2 ,作为跟骨治疗的参照指标 ,临床上使用方便 ;跟骨Bohler′s角、Gissane′s角的改变与跟骨宽度的增加是跟骨骨折诊断、治疗的要点 ;骨折后可参照本文测量结果恢复跟骨的长、宽、高等。

Objective:To provide the morphological standard and basis for the treatment of calcaneal fracture.Methods:The morphological character and trabecular distribution in sagittal and coronal planes was observed on 124 adult calcaneus.Then the length,width,height,Bohler′s angle and Gissane′s angle of calcaneus were measured.Results:Calcaneus has complex morphology and structure,it mainly composed of trabecular bone with very thin cortices bone outside.The trabecular distribution is sparse at anterior part of calcaneus and below the calcaneal sulcus,but it was dense at post medial part of calcaneus.There is no difference between various indexes of left and right calcaneuls.However,except Gissane′s angle,there is a significant difference between various indexes of male and female.The ratio of calcaneal height to length is above 1/2.Conclusions:According to the morphological character,there exist mechanical weakness points on calcaneus,which will lead a complex fracture.The ratio of calcaneal height to length is a convenient index for cacaneus fracture treatment.Both the change of Bohler′s angle and Gissane′s angle and the width of calcaneus increased are very important to calcaneus fracture diagnose and treatment.The dimension of calcaneus in this paper could be a reference to reconstruction calcaneus after fracture.