骨科英文书籍精读（391）｜跟骨骨折的治疗效果
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Outcome
Extra-articular fractures and undisplaced intra-articular fractures, if properly treated, usually have a good result. However, the patient should be warned that it may take 6–12 months before full function is regained, and in about 10 per cent of cases there will be residual symptoms that might preclude a return to their previous job if this involved walking on uneven surfaces or balancing on ladders.
The outcome for displaced intra-articular fractures is much less predictable. The results of operative treatment are heavily dependent on the severity of the fracture and the experience of the surgeon (Buckley et al., 1992; Sanders et al., 1995). The Canadian multicentre study showed a shorter time off work and lower requirement for subtalar arthrodesis in those managed operatively. Results were particularly favourable with internal fixation in younger men and those not working with heavy loads or receiving workmen’s compensation. In experienced hands, for selected fractures, this is a rational treatment. However, it is not an enterprise for the tyro and unless the appropriate skills and facilities are available the patient should be referred to a specializing centre.
Closed treatment, though it may be the only alternative, has a bad reputation. Crosby and Fitzgibbons (1990), in a follow up of 30 patients who had undergone closed treatment, found that 50 per cent of those with uncomplicated displaced intra-articular fractures were contemplating having an arthrodesis within 4 years of injury; only two out of 10 patients had a 'good’ result. Those with comminuted fractures fared even worse: all of them were assessed as having a poor result.
The fact remains that the heel fracture is a serious and disabling injury in many patients with heavy or physically demanding jobs; mechanical reconstruction of the bony anatomy does not necessarily improve the functional outcome.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
preclude /prɪˈkluːd/vt. 排除；妨碍；阻止
The outcome for displaced intra-articular fractures is much less predictable.移位的关节内骨折的结果很难预测。
arthrodesis /ɑ:'θrɔdəsis/关节融合术
DeepL翻译（仅供参考，建议自己翻译）：
结果
关节外骨折和未移位的关节内骨折，如果治疗得当，通常效果良好。但是，应提醒患者，可能需要6-12个月才能恢复全部功能，在大约10%的情况下，如果在不平的表面行走或在梯子上保持平衡，可能会出现残留症状，妨碍他们返回以前的工作。
移位的关节内骨折的结果更难预测。手术治疗的结果在很大程度上取决于骨折的严重程度和外科医生的经验（Buckley等人，1992；Sanders等人，1995年）。加拿大多中心研究表明，在手术治疗的患者中，休息时间更短，距下关节融合术的要求更低。内固定对年轻男性和不从事重负荷工作或不接受工人补偿的男性尤其有利。对于有经验的手，对于选定的骨折，这是一种合理的治疗方法。然而，这不是一个企业的蒂罗，除非有适当的技能和设施，患者应被转介到一个专门的中心。
封闭式治疗虽然可能是唯一的选择，但名声不好。Crosby和Fitzgibbons（1990）对30名接受闭合治疗的患者进行了随访，发现50%的无并发症移位关节内骨折患者考虑在受伤后4年内进行关节融合术；10名患者中只有2名有“良好”的结果。粉碎性骨折患者的情况更糟：所有患者都被评估为结果不佳。
事实仍然是，脚跟骨折对于许多从事繁重或体力劳动的患者来说是一种严重的致残性损伤；骨解剖结构的机械重建不一定能改善功能结果。