距骨体与距骨颈骨折手术疗效分析  

Comparison of curative effects between talar body fractures and talar neck ones

作　　者：李卫华[1] 王岩[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2006年第5期422-425,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨距骨体与距骨颈骨折患者采用切开复位内固定术在治疗和预后上的差异。方法通过对1996年4月～2003年9月间17例SneppenⅡ型距骨体骨折患者与19例HawkinsⅠ、Ⅱ型距骨颈骨折患者均采用切开复位内固定,将Hawkins评分优良率、距骨缺血坏死率、胫距关节创伤性关节炎发生率和距下关节创伤性关节炎发生率进行对比,使用χ2检验确切概率法分析。结果SneppenⅡ型距骨体骨折患者Hawkins评分优良率为64.7%(11/17),距骨缺血坏死率17.6%(3/17),胫距关节创伤性关节炎发生率41.2%(7/17),距下关节创伤性关节炎发生率64.7%(11/17)。HawkinsⅠ、Ⅱ型距骨颈骨折患者Hawkins评分优良率为73.7%(14/19),距骨缺血坏死率15.8%(3/19),胫距关节创伤性关节炎发生率15.8%(3/19),距下关节创伤性关节炎发生率36.8%(7/19)。四种评价指标两组之间比较,差异无显著性意义(P>0.05)。结论距骨体和距骨颈骨折仅是解剖学上的概念,目前对于两种骨折的预后没有区分意义。对有移位(≥2mm)的距骨体或距骨颈骨折患者均应视软组织条件行切开复位内固定,保护残存血运,解剖复位,减少创伤性关节炎和距骨缺血坏死的发生。Objective To compare the curative outcomes of open reduction and internal fixation （ORIF） between talar body fractures and talar neck ones. Methods Seventeen cases of talar body fractures of Sneppen type Ⅱ and 19 cases of talar neck fractures of Hawkins types Ⅰ and Ⅱ were treated with ORIF from April 1996 to September 2003 in our department. Their Hawkins scores, incidence of ischemic necrosis of talus and incidence of traumatic arthritides of tibial-talar joint and subtalar joint were compared and analyzed with Fisher＇s exact test （2-sided） . Results In the 17 cases of talar body fractures of Sneppen type Ⅱ, the good-to-excellent rate of Hawkins scoring, incidence of ischemic necrosis of talus, incidence of traumatic arthritis of tibial-talar joint and incidence of traumatic arthritis of subtalar joint were 64. 7% （11/17）, 17.6% （3/17）, 41.2% （7/17） and 64. 7% （11/17） respectively, while those were 73.7% （14/19）, 15.8% （3/19）, 15.8% （3/19） and 36.8% （7/19） respectively in the 19 cases of talar neck fractures of Hawkins types Ⅰ and Ⅱ. There were no statistical differences in the curative effects between these two kinds of common talar fractures （ P 〉 0. 05 ）. Conclusions Our findings reveal that ORIF will not result in different prognostic outcomes for talar body fractures and talar neck ones. The displaced（ ≥2 mm） fractures of both talar body and neck must be treated by open reduction and internal fixation depending on conditions of soft tissue. We should protect the residual blood supply, reduce the fracture anatomically and decrease the rate of posttraumatic arthritis, ischemia and necrosis of talus.

关 键 词：距骨体骨折 距骨颈骨折 疗效 Hawkins评分 

分 类 号：R687.3[医药卫生—骨科学]