闭合性内侧型距骨周围脱位的治疗  

Treatment of closed medial peritalus dislocation

作　　者：郭明磊 胡伟 张成 GUO Minglei;HU Wei;ZHANG Cheng(Department of Joint Surgery,Zibo Hospital of Traditional Chinese Medicinel,Zibo,Shandong,255000,China)

机构地区：[1]淄博市中医医院关节外科,山东淄博255000 [2]桓台骨伤医院骨科,山东淄博256400

出　　处：《实用手外科杂志》2024年第3期356-358,共3页Journal of Practical Hand Surgery

摘　　要：目的 探讨闭合性内侧型距骨周围脱位的治疗体会。方法 回顾性分析2018年4月-2021年3月收治的11例闭合性内侧型距骨周围脱位患者的临床资料,均因外伤后踝关节疼痛畸形伴活动受限就诊,术前均行X线、CT检查及三维重建,急诊行复位治疗。观察术后并发症及踝关节功能恢复情况。结果 术后11例获得了至少1年随访,无感染、皮肤坏死等并发症出现。随访过程中未发现脱位复发、距骨坏死和距骨周围关节炎情况。视觉疼痛模拟量表(VAS)评分由术前(7.73±1.10)分降至末次随访时的(0.45±0.52)分;踝关节背伸活动度平均为(22.73±6.77)°,跖屈活动度平均为(45.36±2.62)°;末次随访时美国矫形足踝协会足功能(AOFAS)评分为(93.91±5.92)分,其中优8例,良3例,优良率为100%。结论 闭合性内侧型距骨周围脱位会出现皮肤受压,急诊复位可缓解受损皮肤张力,避免皮肤发生坏死。若闭合手法复位失败应尽快切开复位治疗。部分切开复位克氏针固定患者术中未进一步探查修复关节周围韧带也取得了良好的临床治疗效果。Objective To investigate the treatment of closed medial peritalus dislocation.Methods The clinical data of 11 patients with closed medial peritalar dislocation treated from April 2018 to March 2021 were analyzed retrospectively.All patients were treated for post-traumatic ankle pain and deformity with limited movement.All patients underwent X-ray examination,CT examination and three-dimensional reconstruction before operation,and emergency reduction treatment.The postoperative complications and functional recovery were observed.Results Eleven patients were followed up for at least 1 year.There were no complications such as infection and skin necrosis.No dislocation recurrence,talus necrosis and peritalus arthritis were found during follow-up.The score of visual pain analogue scale(VAS)decreased from(7.73±1.10)before operation to(0.45±0.52)at the last follow-up;The average range of motion of the affected ankle was(22.73±6.77)°,and the average range of motion of the affected ankle was(45.36±2.62)°;At the last follow-up,the AOFAS score was(93.91±5.92),of which 8 cases were excellent and 3 cases were good.The excellent and good rate was 100%.Conclusion The closed medial peritalus dislocation can cause skin compression.Emergency reduction can alleviate the tension of damaged skin and avoid skin necrosis.If the closed manipulative reduction fails,open reduction should be performed as soon as possible.Partial open reduction and Kirschner wire fixation in patients without further exploration and repair of periarticular ligaments also achieved good clinical therapeutic effect.

关 键 词：闭合性 距骨周围脱位 复位 并发症 功能 

分 类 号：R687.3[医药卫生—骨科学]