两种入路开放复位内固定距骨颈骨折的比较  

Comparison of two approaches for open reduction and internal fixation of talar neck fractures

作　　者：冯延冰[1] 李春雷[2] 李刚[3] 马胜利[4] FENG Yan-bing;LI Chun-lei;LI Gang;MA Sheng-li(Department of Traumatology,Nanyang Central Hospital,Nanyang 473009,China;Department of Neurorehabilitation,Nanyang Central Hospital,Nanyang 473009,China;The Second Department of Orthopedics,Nanyang Central Hospital,Nanyang 473009,China;Emergency Department,The First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]南阳市中心医院创伤科,河南南阳473009 [2]南阳市中心医院神经康复科,河南南阳473009 [3]南阳市中心医院骨二科,河南南阳473009 [4]郑州大学第一附属医院急诊外科,河南郑州450052

出　　处：《中国矫形外科杂志》2021年第8期694-698,共5页Orthopedic Journal of China

摘　　要：[目的]比较经内踝截骨与非内踝截骨入路开放复位内固定治疗Hawkins Ⅱ、Ⅲ型距骨颈骨折的临床效果。[方法]回顾分析本院手术治疗的Hawkins Ⅱ、Ⅲ型距骨颈骨折120例患者的临床资料,依据医患沟通结果,62例采用内踝截骨入路,58例采用非内踝截骨入路行开放复位内固定。比较两组患者的围手术期、随访和影像学资料。[结果]两组患者均顺利手术,截骨组手术时间、切口长度、术中失血量和住院时间均显著优于非截骨组(P<0.05)。所有患者随访12~32个月,平均(15.52±3.41)个月。截骨组恢复下地行走和完全负重时间显著早于非截骨组(P<0.05)。随时间推移,两组患者VAS评分显著下降(P<0.05),踝背伸-跖屈ROM、足内-外翻ROM和AOFAS评分均显著增加(P<0.05)。末次随访时,截骨组VAS评分、踝背伸-跖屈ROM、踝内翻-外翻ROM和AOFAS评分均显著优于非截骨组(P<0.05)。影像方面,复位优良率截骨组为60/62(96.77%),非截骨组为43/58 (74.14%),两组间差异有统计学意义(P<0.05)。截骨组骨折愈合时间显著早于非截骨组(P<0.05)。至末次随访时,不良影像改变发生率分别为截骨组6/62 (6.45%),非截骨组12/58 (20.69%),差异有统计学意义(P<0.05)。[结论] Hawkins Ⅱ、Ⅲ型距骨颈骨折开放复位内固定,内踝截骨入路显著优于非截骨入路。[Objective] To compare the clinical outcomes of open reduction and internal fixation(ORIF) through medial malleolus osteotomy(MMO) versus non-medial malleolus osteotomy(NMMO) approaches for the treatment of Hawkins type Ⅱ and Ⅲ talar neck fractures. [Methods] A retrospective was conducted on 120 patients who received ORIF for Hawkins type Ⅱ and Ⅲ talar neck fractures in our hospital. According to the results of doctor-patient communication, 62 patients had ORIF performed through the MMO approach, while the remaining 58 patients had the operation finished through the NMMO approach. The two groups were compared regarding to perioperative,follow-up and imaging data. [Results] Both groups of patients were successfully operated. The MMO group was significantly superior to the NMMO group in terms of operation time, incision length, intraoperative blood loss and hospital stay(P<0.05). All patients were followed up for 12 to 32 months, with an average of(15.52±3.41) months. The MMO group returned to walking and full weight bearing activity significantly earlier than NMMO group(P<0.05). The VAS scores decreased significantly(P<0.05), whereas the ankle dorsiflexion-plantarflexion ROM, foot varus-valgus ROM, and AOFAS scores increased significantly in the two groups over time(P<0.05). At the last follow-up,the MMO group was significantly superior to the NMMO group in VAS score, ankle dorsiflexion-plantarflexion ROM, ankle varus-valgus ROM and AOFAS(P<0.05). With respect to imaging evaluation, the excellent and good rate of reduction was 60/62(96.77%) in the MMO group, whereas 43/58(74.14%) in the NMMO group, which was statistically significant(P<0.05). The fracture healing time of the MMO group was significantly earlier than that of the NMMO group(P<0.05). At the latest follow-up, the incidence of adverse image changes was6/62(6.45%) in the MMO group, whereas 12/58(20.69%) in the NMMO group, and the difference between them was statistically significant(P<0.05). [Conclusion] The medial malleolus osteotomy approach i

关 键 词：距骨颈骨折 Hawkins分型 内踝截骨 临床效果 

分 类 号：R683.42[医药卫生—骨科学]