HawkinsⅢ型距骨颈骨折预后的影响因素分析  

Factors influencing prognosis of talar neck fractures of Hawkins typeⅢ

作　　者：邢添威 王岩[1] 李莹[1] 龚晓峰[1] 孙宁[1] Xing Tianwei;Wang Yan;Li Ying;Gong Xiaofeng;Sun Ning(Department of Orthopedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2020年第7期581-586,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的:探讨HawkinsⅢ型距骨颈骨折预后及影响因素。方法:回顾性分析2013年10月至2016年12月北京积水潭医院创伤骨科收治且获得完整随访的18例HawkinsⅢ型距骨颈骨折患者资料。其中男14例,女4例;年龄17~50岁,平均35.1岁。3例为开放性骨折,所有患者均采用一期切开复位内固定治疗。随访时采用美国足踝外科协会(AOFAS)的踝-后足评分评价踝关节及后足功能。收集患者的性别、年龄、吸烟史、饮酒史、体重指数、致伤原因、内踝截骨/骨折、合并骨折、是否为开放性损伤、受伤至手术时间、手术时间、内固定物选择(空心钉/钢板或克氏针)以及有无感染可能影响骨折预后的因素与AOFAS的踝-后足评分进行相关性分析。结果:18例患者术后获21~41个月(平均29.3个月)随访;术后3例患者浅表感染,经换药抗炎治疗后好转;3例患者深部感染,其中2例经清创扩创术后好转,1例最终摘除距骨;6例患者出现胫距关节炎,10例患者出现距下关节炎。末次随访时所有患者的AOFAS的踝-后足评分为12~96分,平均63.4分;距骨发生缺血性坏死6例,塌陷1例。开放性骨折(P=0.015)、手术时间≥3 h(P=0.001)、克氏针固定(P=0.006)、术后感染(P=0.008)与AOFAS的踝-后足评分存在较强的相关性,其他因素与AOFAS的踝-后足评分无相关性(P>0.05)。结论:开放性损伤、手术时间≥3 h、克氏针固定、术后感染是影响HawkinsⅢ型距骨颈骨折的重要因素,合理的治疗方式有助于改善此种类型骨折的预后。Objective To investigate the factors influencing the prognosis of talar neck fractures of Hawkins typeⅢ.Methods A retrospective analysis was performed of the 18 patients with complete follow-up data who had been treated from October 2013 to December 2016 at Department of Orthopedic Trauma,Beijing Jishuitan Hospital for talar neck fractures of Hawkins typeⅢ.They were 14 males and 4 females with an average age of 35.1 years(range,from 17 to 50 years).There were 3 open fractures.All the patients were treated with one-stage open reduction and internal fixation.The American Orthopaedic Foot and Ankle Society(AOFAS)scoring system was used to evaluate the functions of ankle and hindfoot during follow-up.The correlations were analyzed between the ankle-hindfoot AOFAS scores and the factors which might have influenced the prognosis,like gender,age,smoking,alcoholic drinking,body mass index,injury cause,medial malleolus osteotomy/fracture,combined fracture,open injury,interval from injury to surgery,operation time,implants(cannulated/plate or Kirschner wire)and infection.Results The 18 patients were followed up for 21 to 41 months(average,29.3 months).Of them,3 had superficial infection which responded to anti-inflammatory therapy and 3 had deep infection which was improved after debridement in 2 cases and led to eventual removal of the talus in one.Tibiotalar arthritis occurred in 6 patients and subtalar arthritis in 10.The AOFAS ankle-hindfoot scores at the last follow-up for this cohort ranged from 12 to 96 points(average,63.4 points).Ischemic necrosis of the talus was observed in 6 cases and talar collapse in one.The ankle-hindfoot AOFAS scores were strongly correlated with open fracture(P=0.015,)operation time(P=0.001),Kirschner wire fixation(P=0.006),and postoperative infection(P=0.008).Conclusions Since open fracture,operation time≥3 h,Kirschner wire fixation and postoperative infection may be the significant factors that may influence the prognosis of talar neck fractures of Hawkins typeⅢ,reasonable treatme

关 键 词：距骨 骨折 预后 骨坏死 关节炎 

分 类 号：R687.3[医药卫生—骨科学]