内、外侧双切口治疗HawkinsⅢ型距骨颈骨折  

Radiographic and functional results of the Hawkins Ⅲ talus neck fractures via internal and lateral approaches

作　　者：张文海[1] 卢艳东[1] 王敬博[1] 张克刚[1] 郑玉晨[1] 姚辉[1] 李宝和[1] 王裕民[1] 

机构地区：[1]天津市天津医院骨科,300211

出　　处：《中华骨科杂志》2012年第8期745-750,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨HawkinsⅢ型距骨颈骨折的手术注意事项及I临床疗效。方法2005年3月至2010年3月手术治疗HawkinsⅢ型距骨颈骨折26例，完整随访资料者21例，男13例，女8例；年龄18-50岁，平均37．6岁；左侧11例，右侧10例。坠落伤13例，车祸伤7例，滚落伤1例。闭合骨折15例，开放骨折6例。所有患者均急症采用内、外侧双切1：3显露、复位骨折，空心拉力螺钉内固定。术后非负重功能位外固定6周，后在铰链支具保护下行踝关节伸屈锻炼，12-16周后根据X线片骨折愈合情况决定是否允许负重，并根据随访结果调整负重量。末次随访时根据美国足与踝关节外科协会（American Orthopaedic Footand Ankle Society，AOFAS）制定的踝与后足功能评分系统评定术后功能。结果21例患者术后随访6-60个月，平均36．6个月。平均骨折愈合时间4．5个月，无骨折不愈合。末次随访时AOFAS踝与后足功能评分为45-97分，平均78．6分。优4例、良10例、可5例、差2例，优良率为67．8％。13例患者发生创伤性关节炎，发生率为61．9％（13／21），累及胫距关节者4例，累及距下关节者6例，同时累及胫距关节、距下关节者3例。发生不同程度距骨缺血性坏死5例，发生率为23．8％（5／21）。结论急症采用内、外侧双切口显露、复位骨折，空心拉力螺钉内固定治疗Hawkins Ⅲ型距骨颈骨折疗效满意。术中注意保护残存血运，根据距骨体三维立体移位特点施行解剖复位，如骨折端粉碎需采取结构性植骨。术后应遵循早运动、晚负重的原则指导功能康复。Objective To investigate the clinical results and related key points of surgical treatment for Hawkins m talus neck fractures. Methods From March 2005 to March 2010, 26 patients with Hawkins Ⅲ talus neck fracture were treated and 21 of them were followed, including 13 males and 8 females, with an average age of 37.6 years. The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The mechanism of injury included high failing injury in 13 patients, traffic accident injury in 7 patients and roiling down injury in 1 patient. Five cases were closed fractures and 6 cases were open fractures. A bilateral approach, the medial and lateral approaches, was used to perform the operation with cannulated screw fixation in emergency. After external fixation in functional position for 6 weeks without loading, ankle joints were allowed to take exercise with hinge brace and to bear partially basing on plain radiograph 12-16 weeks later. The weight-bearing should be adjusted with follow-up. Functional results were assessed accord- ing to AOFAS （American Orthopaedic Foot and Ankle Society, AOFAS）score. Results The average duration of follow-up was 36.6 months （range, 6-60 months）. All fractures gained union and the average union time was 4.5 months. The average AOFAS score was 78.6. There were 4 cases in excellent results, 10 in good, 5 in fair and 2 in poor. The overall excellent and good rate was 67.8%. Traumatic arthritis occurred in 13 cases and avascular necrosis in 5 cases. Conclusion The effect of surgical treatment for Hawkins Ⅲ talus neck fracture via a bilateral approach is satisfactory.

关 键 词：距骨 骨折固定术 内 预后 

分 类 号：R687.3[医药卫生—骨科学]