距下关节脱位伴距骨后突骨折一例及文献复习  

Subtalar dislocation associated with fracture of the posterior process of the talus： a case report and review of the literature

作　　者：张程[1] 王庆贤[1] 周亚斌[1] 赵士猛[1] Zhang Cheng;Wang Qingxian;Zhou Yabin;Zhao Shimeng(Emergency Center of Trauma,the Thrid Affiliated Hospital of Hebei Medical University,Orthopaedic Research Institution of Hebei Province,Key Laboratory of Orthopaedic Biomechanics of Hebei Province,Shifiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院骨科创伤急救中心河北省骨科研究所河北省骨科生物力学重点实验室,石家庄05005l

出　　处：《中华解剖与临床杂志》2018年第3期251-257,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的报道1例少见的距下关节内侧脱位伴距骨后突骨折病例的诊断和治疗，探讨距骨后突周围解剖、距下关节内侧脱位伴距骨后突骨折发生机制、诊断及治疗。方法回顾性分析1例25岁男性距下关节内侧脱位伴距骨后突骨折患者的临床资料。在PubMed、中国知网、万方数据及维普数据库中，以“距下关节脱位／subtalar dislocation”和“距骨后突骨折／posterior process fracture of talus”为关键词，检索2017年10月前有关距下关节脱位伴距骨后突骨折的相关文献，共纳入6篇6例距下关节脱位伴距骨后突骨折的英文文献报道和1篇1例中文文献报道；结合本例诊治过程，总结该损伤临床及影像学表现、损伤机制、诊断及治疗方法。结果本文1例青年男性因车祸伤致右足内翻畸形、疼痛、肿胀、活动受限，正侧位x线平片示右距下关节内侧脱位伴后踝游离骨块，急诊行右距下关节脱位闭合复位石膏固定术。急诊术后x线片示距骨外旋，CT平扫示距跟关节间隙增宽、距骨后突骨折、足舟骨撕脱骨折，择期行右距下关节脱位伴距骨后突骨折切开复位内固定术；择期手术后距下关节及距骨后突复位良好，随访6个月患者踝关节活动可，未诉疼痛。结合文献报道的7例，共8例距下关节脱位伴距骨后突骨折，男7例、女1例，年龄17-52岁，均表现为伤后足内翻畸形、肿胀、疼痛、活动受限；X线示距胫关节稳定，足内翻、距下关节内侧脱位，后踝存在游离骨折块；治疗以切开或闭合复位内固定为主要手术方式；距骨后突解剖复位并石膏固定者术后功能恢复好，无关节不稳、创伤性关节炎等相关并发症。结论当足遭受跖屈内翻暴力时距下关节可发生内侧脱位，同时距骨后突遭受距跟韧带的牵拉暴力形成撕脱骨折。距下关节脱位合并无移位或移位≤2mm的距骨后突骨折可保守治疗，�Objective Subtalar dislocation associated with fracture of the posterior process of talus is very rare. The diagnose and treatment about this rare case was reported and the related literatures were reviewed to summarize the anatomy of the posterior process, mechanism and treatment of this pattern injury. Methods The literatures about the Subtalar dislocation associated with fracture of posterior process of talus before October 2017 were searched in PubMed, CNKI, Weipu and Waiffang database by using ＂subtalar dislocation＂ and ＂posterior process fracture of talus＂ as key words. Six cases reported in English and 1 case reported in Chinese were detected. The clinical and imaging findings, mechanism of this pattern injury, treatment and clinical prognosis of 7 cases reported in literature and 1 case in this paper were observed and analysed. Results A 25-year-old male suffered an traffic accident was presented with pain, swelling, malformation and activity limitation at the right ankle. The X-ray revealed subtalar dislocation and an unconfirmed fracture. The closed reduction and plaster fixation were performed immediately to correct the subtalar dislocation but the result was not satisfying. X-ray and CT scan revealed subtalar medial dislocation associated with navieular fracture and posterior process fracture of talar. The patient underwent open reduction and internal fixation 27 days later after the accident and got a good result in 6 months after operation. Eight cases of subtalar dislocation associated with fracture of the posterior process of talus are involved, including 1 case in this paper and 7 cases reported, 7 males and 1 female, age ranges from 17 to 52 years old, all the patients were presented with pain, swelling, malformation and activity limitation at the ankle. Seven cases underwent open reduction and internal fixation and 1 case was treated by minimally invasive technique. The X-ray and CT scan revealed a good reduction after open reduction and internal fixation. There was no pain at the hindf

关 键 词：距下关节 脱位 距骨后突 骨折 治疗 

分 类 号：R687.3[医药卫生—骨科学]