经内踝"V"型截骨入路空心钉内固定治疗Sneppen Ⅴ型距骨体骨折  

Operative treatment of Sneppen Ⅴ talus fracture through approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation

作　　者：郝增涛[1] 王小龙[1] 殷超[1] 王继宏[1] 温树正[1] 王永飞[1] 姜东 张国荣 Hao Zengtao;Wang Xiaolong;Yin Chao;Wang Jihong;Wen Shuzheng;Fan Dongsheng;Wang Yongfei;Jiang Dong(Department Ⅱ of Hand & Foot Microsurgery, The Second Affiliated Hospital to Inner Mongolia Medical University, Hohhot 010030, China)

机构地区：[1]内蒙古医科大学第二附属医院手足显微二科,呼和浩特010030

出　　处：《中华创伤骨科杂志》2019年第10期910-913,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨经内踝"Ⅴ"型截骨入路空心钉内固定治疗Sneppen Ⅴ型距骨体骨折的疗效。方法回顾性研究2015年1月至2019年1月内蒙古医科大学第二附属医院手足显微外科诊治的16例Sneppen Ⅴ型距骨体骨折患者资料。患者男14例,女2例;年龄20~55岁,平均38.4岁。均采用经内踝"Ⅴ"型截骨入路空心钉固定治疗,采用美国足踝外科协会(AOFAS)的踝-后足评分系统评价术后功能。结果所有患者均获随访,时间平均为12.6个月(6~30个月),手术时间平均为68.4 min(52~96 min),术中出血量平均为96.8 mL(48~122 mL),骨愈合时间平均为4.8个月(3~8个月)。术后AOFAS的踝-后足评分平均为75.3分(43~91分)。4例患者发生并发症。术后切口均一期愈合,未发生感染、内固定物断裂、骨折延迟愈合及不愈合等并发症。结论经内踝"Ⅴ"型截骨入路空心钉内固定治疗Sneppen Ⅴ型距骨体骨折,手术视野显露充分、方便骨折复位和坚强固定,能有效降低距骨坏死及创伤性关节炎的发生率。Objective To report the effects of operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation. Methods From January 2015 to January 2019, 16 patients with Sneppen Ⅴ talus fracture were treated at Department Ⅱ of Hand & Foot Microsurgery, The Second Affiliated Hospital to Inner Mongolia Medical University. They were 14 men and 2 women with a mean age of 38.4 years (range, from 20 to 55 years). All fractures were fixed with hollow compression screws through the approach for malleolus medialis Ⅴ osteotomy. The ankle and hindfoot functional scoring system developed by American Orthopaedic Foot and Ankle Society (AOFAS) was used to evaluate the clinical outcomes. Results All patients were followed up for a mean time of 12.6 months (range, from 6 to 30 months). The mean operation time was 68.4 minutes (range, from 52 to 96 minutes);the mean amount of hemorrhage during operation was 96.8 mL (range, from 48 to 122 mL);the mean period of bone union was 4.8 months (range, from 3 to 8 months). The postoperative mean AOFAS score was 75.3 points (range, from 43 to 91 points). Complications occurred in 4 cases, including one case of talus ischemic necrosis, one case of partial talus ischemic necrosis accompanied by tibial arthritis, one case of subtalar arthritis, and one case of combined tibial, talar and subtalar arthritis. All incisions obtained primary healing, with no complications like infection, screw breakage, delayed union or nonunion. Conclusion Operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation can provide sufficient operative exposure to facilitate reduction and fixation of the talus fracture so that the ischemic necrosis of the talus and traumatic arthritis can be effectively reduced.

关 键 词：距骨 骨折 骨折固定术 内 骨钉 内踝截骨 

分 类 号：R687[医药卫生—骨科学]