内外侧联合入路治疗伴距骨脱位的距骨颈骨折  

Combined medial and lateral incisions for treatment of talar neck fracture with talar dislocation

作　　者：李兵[1] 杨云峰[1] 陈凯[1] 于涛[1] 朱辉[1] 张明珠[1] 赵有光[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中华创伤杂志》2015年第2期107-110,共4页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（81472144）

摘　　要：目的 探讨内外侧联合入路治疗伴距骨脱位的距骨颈骨折的治疗方法及疗效.方法 选择2010年1月-2013年1月收治的伴距骨脱位的距骨颈骨折患者12例,其中男10例,女2例;年龄25～ 42岁,平均32.5岁.根据改良Hawkins分型：Ⅱ型骨折9例,Ⅲ型骨折3例.所有患者均采用内外侧联合入路：7例Ⅱ型骨折为相对简单骨折,采用切开复位螺钉内固定术,2例Ⅱ型骨折和3例Ⅲ型骨折为距骨颈粉碎性骨折,采用微型钢板加螺钉内固定术.采用美国足踝外科协会（AOFAS）评分评价踝和后足功能. 结果 10例获得随访18 ～48个月,平均30个月.伤口Ⅰ期愈合,无感染.术后AOFAS评分为（78.5±8.9）分（66 ～90分）.术后距骨颈骨折平均愈合时间12.5周（10～ 16周）.距骨发生缺血性坏死3例,均为粉碎性骨折,其中Ⅱ型骨折1例,Ⅲ型骨2例,未发生距骨体塌陷.2例采用非手术治疗,减少活动及负重3个月后症状减轻;1例因距下关节退变严重行距下关节融合术. 结论 内外侧联合入路治疗伴距骨脱位的距骨颈骨折可获得满意的复位及疗效,是治疗伴距骨脱位的距骨颈骨折的有效方法.Objective To investigate the effect of treatment of talar neck fractures with talar dislocation via medial and lateral incisions.Methods Between January 2010 and January 2013,12 cases of talar neck fracture with talar dislocation were operated on via medial and lateral incisions.There were 10 males and 2 females with mean age of 32.5 years （range,25-42 years）.According to the modified Hawkins classification,there were 9 cases of type Ⅱ and 3 type Ⅲ.Seven cases of simple fracture （type Ⅱ） underwent open reduction and screw internal fixation.And five cases of comminuted fracture comprising 2 type Ⅱ and 3 type Ⅲ underwent internal fixation with mini-plates and screws.American Orthopedic Foot and Ankle Society （AOFAS） score was used for evaluation of ankle and hindfoot disorders.Results Ten patients were followed up for mean 30 months （range,18-48 months）.No wound healing problems or infections were seen.Mean postoperative AOFAS score was （78.5 ± 8.9）points （range,66-90 points）.Mean time to fracture healing was 12.5 weeks （range,10-16 weeks）.Talar avascular necrosis was documented in 3 cases of comminuted fracture （1 type Ⅱ and 2 type Ⅲ）,but none of them had collapse of the talar body.Two cases experienced the relieve of osteonecrosis 3 months after conservative therapy by decreasing activity and weight-bearing and one case underwent subtalar arthrodesis because of posttraumatic arthritis.Conclusion Combined medial and lateral incisions attains good results in treatment of talar neck fractures with talar dislocation.

关 键 词：距骨 脱位 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]