SneppenⅡ型距骨体骨折的手术技巧及疗效分析

The operative techniques for Sneppen type Ⅱ fractures of talar body

目的探讨距骨体SneppenⅡ型骨折的手术技巧及疗效。方法对1998年1月～2004年12月收治的21例距骨体SneppenⅡ型骨折患者的随访资料进行总结。术前常规行距骨CT扫描，根据距骨体主要移位骨折块的位置选择内侧和（或）外侧入路。手术大多采用内踝截骨入路，15例采用半螺纹钛钉或空心钉固定，3例采用可吸收钉固定，3例采用克氏针固定。结果所有患者获得12～90个月（平均38个月）随访。术后6例出现距骨缺血性坏死，其中5例踝关节及距下关节均出现创伤性关节炎；另有3例踝关节和5例距下关节出现创伤性关节炎。5例行关节融合术。踝关节功能采用美国足踝骨科协会（AOFAS）评分：优8例，良5例，可3例，差5例，优良率为61．9％。结论距骨体SneppenⅡ型骨折应通过选择正确的手术入路，尽量使骨折达到解剖复位及保护血运的效果；术后力争早期主动无痛进行踝关节功能锻炼。

Objective To discuss the operative techniques for the Sneppen type Ⅱ fractures of talar body and the therapeutic effects. Methods From January 1998 to December 2004, 21 cases of the Sneppen type Ⅱ talar body fractures were managed in our hospital. They were 16 men and 5 women. Their ages raged from 14 to 50 years, averaging 28.1 years. CT scanning of talus was done preoperatively to determine the operative approach. Osteotomy of medial malleolus was applied in most cases. Fifteen cases were fixated with half-threaded screws or cannulated screws, 3 with absorbable screws and 3 with K-wires. Results All the cases were followed up for a mean time of 38 months （ 12 to 90 months）. Avascular necrosis was found in 6 cases, 5 of which had traumatic arthritis at ankle and subtalar joints. Traumatic arthritis also occurred at 3 ankles and 5 subtalar joints. Arthrodesis was performed for 5 cases. According to the ankle and hindfoot scores of American Orthopaedic Foot ＆ Ankle Society （AOFAS）, 8 patients had excellent results, 5 good, 3 fair, and 5 poor. The overall excellent and good rate was 61.9%. Conclusion The key points in the treatment of the talar body fractures are anatomical reduction, stable internal fixation, preservation of the blood supply and early active pain-free motion with a right approach and fine operative techniques.