外固定架联合螺钉治疗开放性距骨颈骨折的临床研究

Clinical Study of External Fixator Combined with Screws in the Treatment of Open Talar Neck Fracture

目的探讨外固定架联合螺钉治疗开放性距骨颈骨折的临床疗效。方法回顾性分析2013-07/2018-03月采用手术治疗的8例Ⅱ度距骨颈开放性骨折患者资料。急诊行清创、骨折复位、螺钉内固定联合外固定架治疗。统计创口愈合、骨折愈合时间、距骨缺血坏死发生率,评估末次随访Philips&Schwartz评分及美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)评分。结果8例患者平均随访18个月(12~36月),2例患者皮肤表层出现坏死,经换药在2周内愈合,其余均一期愈合;无感染病例。踝活动度:背伸平均10°,较健侧差14°(5~20°);跖屈25°,较健侧差10°(10~30°)。距下关节活动:内翻10°,较健侧差15°(10~25°);外翻5°,较健侧差25°(15~25°)。Philips&Schwartz评分81.4分(76~90分);AOFAS的踝-后足评分平均86.3(80~95分)。术后未出现关节不稳定,发现距骨坏死1例,关节退变5例,未出现创伤性关节炎患者。结论开放性距骨颈骨折发生率低,但预后不佳。距骨颈骨折行解剖复位加压螺钉内固定,后外固定架辅助固定,为软组织愈合创造了稳定环境,利于控制感染,临床效果良好。

Objective To investigate the clinical effect of external fixator combined with screws in the treatment of open talar neck fracture.Methods A total of 8 patients withⅡdegree open fracture of the talus neck who received complete surgical treatment from July 2013 to March 2018 were retrospectively analyzed.Debridement,reduction of fracture,internal fixation and combined external fixation were performed in emergency.The time of wound healing,fracture healing and the incidence rate of talus avascular necrosis were counted.The Philips&Schwartz score and American orthopaedic foot and ankle society(AOFAS)score were evaluated in the last follow-up.Results A total of 8 patients were followed up for an average of 18 months(12-36 months),2 patients had necrosis on the skin surface,healed within 2 weeks after dressing change,the rest healed in one stage,no infection.Ankle mobility:average dorsiflexion was 10°,14°(5-20°)less than the healthy side;plantar flexion was 25°,10°(10-30°)less than the healthy side.Subtalar joint movement:varus was 10°,15°(10-25°)less than the healthy side;valgus was 5°,25°(15-25°)less than the healthy side.Philips&Schwartz score was 81.4(76-90),and AOFAS score was 86.3(80-95)on average.There was no instability of the joint after the operation,1 case of talus necrosis,5 cases of joint degeneration,and no traumatic arthritis.Conclusion Open talus neck fractures has a low incidence but poor prognosis.Anatomical reduction and compression screw internal fixation for talus neck fracture,assisted by posterior external fixator,created a stable environment for soft tissue healing,which is conducive to infection control and achieved good clinical results.