外固定支架联合带血管骨瓣植骨在距骨颈骨折治疗中的应用  

Treatment of talar neck fractures with external fixators combined with vascularized bone graft

作　　者：张秋林[1] 王秋根[1] 张少成[1] 唐昊[1] 李凌[1] 纪方[1] 麻文谦[1] 汪方[1] 汤旭日[1] 谢杨[1] 王万宗[1] 吴剑宏[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中华创伤骨科杂志》2006年第5期426-429,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨外固定支架联合带血管骨瓣植骨治疗距骨颈骨折的疗效。方法回顾性分析2004年1月～2005年3月收治的7例距骨颈骨折患者,按Hawkins分型:Ⅱ型6例,Ⅲ型1例,分别采用手法闭合复位(1例)和切开复位(6例)经皮空心螺钉内固定治疗,7例患者均在上述处理后加外固定支架跨关节固定联合带血管的骨瓣植骨治疗。术后观察骨愈合、骨坏死及后足功能情况。结果7例患者均获得随访,随访13～24个月,平均17个月。7例均获骨性愈合,无一例发生缺血性骨坏死。后足功能按Maryland评分系统进行评估,结果:优5例,良2例。1例合并距骨体骨折患者出现明显的胫距关节骨关节炎,最后行胫距关节融合术。结论外固定支架联合带血管骨瓣植骨能有效地防止距骨颈骨折后缺血性骨坏死,但远期效果尚须进一步观察。Objective To evaluate the effects of external fixators combined with vascularized bone graft in treatment of talar neck fractures. Methods We retrospectively reviewed the records of seven patients who were treated for fractures of talar neck from January 2004 to March 2005 in our department. Of them, six were type Ⅱ and one was type Ⅲ according to the Hawkin＇s classification. One case was managed with closed reduction and six with open reduction and internal fixation with pereutaneous cannulated screws. In addition, all the patients were treated with transarticular external fixators combined with vascularized bone graft. Bone healing, osteonecrosis and hindfoot functional recovery were documented. Results All the patients were followed up for 13 to 24 months （average, 17 months）. All of them achieved bony union. According to the Maryland hindfoot scoring system, five cases were excellent and two were good. No avascular necrosis was found. One patient complicated with talar body fracture developed posttraumatic arthritis that was later managed by tibiotalar fusion. Conclusions External fixators combined with vascularized bone graft can effectively prevent avascular necrosis of the talus, but the long-term effects of this method need further observation.

关 键 词：距骨颈 骨折 外固定支架 骨折固定术 带血管骨移植 

分 类 号：R687.3[医药卫生—骨科学]